Permit CITY TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2004 -00047
DEVELOPMENT Tigard, ) 639-4171
DATE ISSUED: 2/17/04
13125 SITE ADDRESS; 15570 SW PACIFIC HWY PARCEL: 2S110DC -02200
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 JURISDICTION: TIG
TENANT NAME: SAFEWAY #1478
USA NO: FIXTURE UNITS: 3
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .3 EDU increase.
Owner: FEES
TIGARD, CENTER LP
9777 WILSHIRE BLVD #609 Description Date Amount
BEVERLY HILL, CA 90212 [SWUSA] Swr Connect 2/17/04 $720.00
[SWUSA] Swr Connect 2/17/04 $0.00
Phone:
Total $720.00
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. 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 a "Tap and Side Sewer" Perm
O
Issued by' `` _ _ _ Permittee Signature: "
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day