Permit � , CITY OF TIGARD SEWER CONNECTION PERMIT
r DEVELOPMENT SERVICES PERMIT #: SWR2005 -00232
c � J I � 1 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/25/2005
PARCEL: 25111 BD -00412
SITE ADDRESS: 09700 SW MARILYN CT ZONING: R - 3.5
SUBDIVISION: DARMEL NO. 3 LOT: 029 JURISDICTION: TIG
Project Description: Connect existing house to sewer service. Reimbursement District #27 fee paid this date. ,
TENANT NAME: •
CWS NO: FIXTURE UNITS: • CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
RICHARD LUNDSTROM Description Date Amount
9700 SW MARILYN CT
TIGARD, OR 97224 [SWUSA] Sewer Connection Fee 7/25/2005 $2,600.00
[SWINSP] Sewer Inspection Fee 7/25/2005 $35.00
Phone: 503 684 - 0472 Total $2,635.00
Contractor:
REQUIRED ITEMS AND REPORTS
Phone:
Reg #: .
•
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The pi rmit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency d not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, . - ins :Her shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall , . r• ase a :p a P• Side Sewer"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires yo to ollow -s adipted by the
Oregon Util 6. otification Center. Those rules are set forth in OAR 952 -001 -0010 through O' - 952 .1 I : ::. • •
may • - in copies o hese les or direct questions to OUNC by calling 503-246-66!9 or 1-?= e; :44.
/ _' i , .
Iss ed b / ' = /� , I ` Permittee Signature: •,
Y i g '�
Call 503 -639 -4175 by 7:00 a.m. for an inspection that busine s day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans am required on the job site at the time of each inspection.