Permit CITY TIGARD SEWER CONNECTION PERMIT
r,lt� DEVELOPMENT SERVICES PERMIT #: SWR2002 -00259
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/10/02
SITE ADDRESS; 14011 SW RIDGEFIELD LN PARCEL: 2S109AA 06000
SUBDIVISION: ZONING:
BLOCK: , LOT: JURISDICTION:
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF.
Owner: FEES
KOZAK ENTERPRISES INC
22830 SW NOBLE ST Description Date Amount
BEAVERTON, OR 97007 [SWUSA] Swr Connect 10/10/02 $2,300.00
[SWINSP] Swr Inspect 10/10/02 $35.00
Phone: 503- 848 -7014
Total $2,335.00
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
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Issu d by: . , 1 :!ii, 0 4, / ' ' Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day