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Permit CITY OF TIGARD A A, ���� ; i :A, DEVELOPMENT SERVICES SEWER CONNECTION r'� L 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT PERMIT # SWR99 -0045 DATE ISSUED: 03/04/99 PARCEL: 1S136AD -04301 SITE ADDRESS...:11475 SW PACIFIC HWY SUBDIVISION •VILLA RIDGE ZONING: C —G BLOCK LOT •002 JURISDICTION: TIG TENANT NAME •TIME OUT PUB USA NO • FIXTURE UNITS...: 4 CLASS OF WORK... :ALT DWELLING UNITS..: 1 TYPE OF USE •COM NO. OF BUILDINGS: 1 INSTALL TYPE •BUSWR IMPERV SURFACE: 0 sf Remarks: Install new plumbing. Owner: FEES TIME OUT PUB type amount by date recpt 11475 SW PACIFIC HWY PRMT $ 2300.00 DEB 03/04/99 99- 313437 TIGARD OR 97223 Phone #: Contractor: OWNER Phone #: $ 2300.00 TOTAL Reg #..: REQUIRED INSPECTIONS This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase I a "Tap and Side Sewer° Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001 -0010 4'R 952- 0001-0080. You may obtain copies of these rule or direct qu ions to OUNC by calling (503)246 -1987. /i�� Issued y : _ � /.r �i . ri Permittee Signatur �.' — - ' .` +++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day +++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Accumulative Sewer Tally Tenant Name: Tnia. Ozer Peig This SWR# 9 9 -coy 5 Address: / /y7S 5t-) 1)He,, - / ' f>/u✓ This PLM #: 9q r,0 1 Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New # Value Capped off value added # added #s total • Count off #s count value values Baptistry/Font 4 Bath - Tub /Shower 4 - JacuzziWhirlpool 4 Car Wash - Each Stall 6 - Drive Through 16 . Cuspidor/Water Aspirator 1 Dishwasher - Commercial 4 / 9 f - Domestic 2 -`\ Drinking Fountain 1 • Eye Wash 1 • Floor Drain/sink - 2 inch 2 1 7 Z- - 3 inch 5 • - 4 inch 6 - Car Wash Dm 6 Garbage Disposal • 16 - Domestic (to 3/4 HP) - Commercial (to 5 HP) 32 - Industrial (over 5 HP) 48 Ice Machine/Refrigerator Drains 1 Oil Sep (Gas Station) 6 . • Rec. Vehicle Dump Station 16 Shower - Gang (Per Head) 1 - Stall 2 Sink - Bar/Lavatory 2 - Bradley 5 - Commercial © r? 6 Z . CO - Service 3 — — — Swimming Pool Filter 1 Washer - Clothes 6 Water Extractor 6 Water Closet - Toilet 6 _ Urinal 6 TOTALS 1.1 4 / ° 76 Total fixture values: divided by 16 = y 75 EDU = S EDy ° DD / ..--6 e"Iesrr� ( 0-tiefir P it - vi- 3 -1 - Q1 HISTORY Cuae(f#d r c9/""" - /5 Fok y EIPUs PLM# EDU# / SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# i:ldsts\swrtaly.doc 6 /30 /99 . Activities for Case #: SWR99 -00045 2:36:27 PM Assigned Hold Updated Activity Description - Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes SWRC003 Application received 3/1/99 GEO RECD GEO 3/1/99 • SWRC008 Permit Created 3/1/99 GEO DONE GEO 3/1/99 SWRCO32 DST Post - Review Completed 3/3/99 B DONE BON 3/3/99 SWRC070 Ready to issue . 3/3/99 B MEMO BON 3/3/99 Must issue this permit although no inspection is required. Case final in actions and send paperwork to Jeanne. SWRC080 (F) Issue permit 3/4/99 DEB DONE DST 3/4/99 SWRC720 Case Fineled 3/4/99 DEB DONE DST 3/4/99 No inspection, permit for DU . increase. • • • • • • Page 1 of 1