Permit A- CITY OF TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2001 -00086
,ti DEVELOPMENT SERVICES DATE ISSUED: 4/10/01
-' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 13099 SW RAPTOR PL PARCEL: 2S104DA -08300
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R-4.5
BLOCK: LOT: 069 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF detached rowhouse. •
Owner: FEES
BROWNSTONE HOMES Type By Date Amount Receipt
12670 SW 68TH PKWY #200
PORTLAND, OR 97223 PRMT CTR 4/10/01 $2,300.00 27200100000
INSP CTR 4/10/01 $35.00 27200100000
Phone: 503 - 598 -7565 Total $2,335.00
Contractor:
Phone:
Reg #:
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Required Inspections
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This Applicant agrees to comply with all the rules and regulations of the Unified Sewage.Agency. T e permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. Tr e • :. ncy does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measure en 1 • - n, the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer s all p ase a "Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon la r- uires u to • , w rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -011 -00 0 thro gh I • ' : 52- 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503 24.- S "
Issued by: Permittee Signature: •
Ca (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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