Permit CITY TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2002 -00055
DEVELOPMENT SERVICES DATE ISSUED: 8/29/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 13058 SW PRINCETON LN PARCEL: 2S104DA -20400
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R-4.5
BLOCK: LOT: 030 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTP IMPERV SURFACE:
Remarks: Sewer connection
Owner: FEES
BROWNSTONE QUAIL HOLLOW LLC Type By Date Amount Receipt
12670 SW 68TH PKWY STE 200
PORTLAND, OR 97223 PRMT CTR 8/28/02 $2,300.00 27200200000
INSP CTR 8/28/02 $35.00 27200200000
Phone: 503- 598 -7565 Total $2,335.00
Contractor:
Phone:
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 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 o • copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issue by: C i Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day