Permit SEWER CONNECI ION
CI1YOFTIQAR PERMIT
PERMIT.# SWR95 -0317
DATE ISSUED: 10/19/95
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PARCEL: 2S1 10DB -00700
SITE ADDRESS...: 15570 SW PACIFIC HWY
SUBDIVISION • WILLOW BROOK FARM ZONING: C —G
BLOCK • LOT •10
TENANT NAME - SAFEWAY
USA NO • FIXTURE UNITS...:311
CLASS OF WORK...:NEW DWELLING UNITS..:19
TYPE OF USE •COM NO. OF BUILDINGS:1
INSTALL TYPE •LTPSWR IMPERV SURFACE..:403801 :sf
Remarks: 54,142 sq. ft. single story grocery store
Owner: FEES
STERLING DEVELOPMENT CORPORATION type amount by date recpt
LA JOLLA CORPORATE CENTER PRMT $ 41800.00 JSD 10/19/95 95- 271865
A 3252 HOLIDAY COURT, SUITE 225 INSP $ 45.00 JSD 10/1 95- 271865
LA JOLLA CA 92037
Phone #: 619 -546 -8841
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 41845.00 TOTAL
Reg #..:
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 180 days from
the date issued. The total amount paid will be forfeited if the
f 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° Permit and the Agency wij1 install - lateral.
Permittee Si • • • 'e: L I . Al
Issued By a 1' a
Call for inspection — 639 -4175
Accumulative Sewer Tally v��
Address• 1.5570 5VJ Pa(1� C This PLM #: Pal4q" 6Ig3
k1 IK q(S- 031/
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New New
# Value Capped off value added # added total #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4 ,
- Jacuz/Whpl 4
Cuspidor/Water Asp 1
Dishwasher - Commer 4 I
- Domest 2
Drinking Fountain 1 I 1 I QQ
Floor Drain - 2 inch 2 1 f5D
- 3 inch 5
- 4 inch 6 I (0
Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm (to 5 HP) 32 I 3; 3 e
- Ind (over 5 HP) 48
Oil Sep (Gas Ste) 6
Shower - Gang 1
- Stall 2
Sink - Bar (1.40 2 I LI
- Bradley 5 i u
- Commercial 3 1 3 I )"
- Service 3
Washer, Clothes 6
Water Ext 6 f'
Water Closet 6 1 L 4 A
Urinal 6 2"" b I X
TOTALS 3 I
Total fixture values: Z' I) divided by 16 = I 4,3 EDU
HISTORY
PLM# ' - ' EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
1/21/00 Activities for Case #: SWR95 -00317
4:30:25 PM
Assigned Hold Updated
Activity Description Date.1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA007 APPlication received 7/28/95 JD PEND B 8/8/95
SWRA705 Sewer Inspection 4/2/96 TLP PASS TLP 4/2/96
SWRA070 Ready to issue 10/6/95 JDA PASS JDA 10/6/95
SWRA080 (F) Issue permit 10/19/95 JSD PASS JD 10/19/95
SWRA720 Case Finaled 4/2/96 TLP PASS TLP 4/2/96
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