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4A CITY OF TIGARD SEWER CONNECTION PERMIT
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• • PERMIT #: SWR2000 -00005
- 13125 j41.°111 DEVELOPMENT H BMENg OR 2CES • 639 -4171 DATE ISSUED: 01/18/2000
SITE ADDRESS; 08990 SW PIPPEN LN PARCEL: 2S111DA -15500
SUBDIVISION: APPLEWOOD PARK NO. '3 ZONING: R -7
BLOCK: LOT: 148 JURISDICTION: TIG
TENANT NAME: LEGEND HOMES
USA NO: , • FIXTURE UNITS: 0
CLASS OF WORK: NEW DWELLING UNITS:- 1
. TYPE OF USE SF NO. OF BUILDINGS: '
INSTALL TYPE: LTPSWR IMPERV SURFACE:
• Remarks: Sewer connection for a new single family dwelling.
Owner:
FEES
LEGEND HOMES
12600 SW 72ND AVE Type. By Date Amount Receipt
• TIGARD, OR 97223 • ' ' PRMT GEO ' 01/18/200C $2,300.00 00- 321187
INSP GEO ' 01/18/200C $35.00 00- 321187
Phone: 620 -8080 • ' Total $2,335.00 _
Contractor: • -
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Phone: •
Reg #: •
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Required Inspections • • - Sewer Inspection •
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ORIGINAL
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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 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" 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 through OAR 952- 001 -0080.
You may obtain copies of thes- rules o ' irect questions to OUNC by calling (503) 246 -1987.
Issued by: Permittee Signature:
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Call (503) 63! -4175 by 7:00 P.M. for an inspection needed the next busi s ay
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