Permit A • CITY OF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
d�l
PERMIT
13125 SW Hall Blvd., Tigard, 0R 97223 (503) 639 - 4171 PERMIT # SWR98 - 0303
DATE ISSUED: 11/30/98
PARCEL: 2S104DB -02900
SITE ADDRESS•. °:13037 SW ROCKINGHAM DR
SUBDIVISION °AMESBURY HEIGHTS ZONING: R -4 °5
BLOCK LOT •029 JURISDICTION: TIG
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TENANT NAME °BAKER, KEITH
USA NO • FIXTURE UNITS•°.: 0
CLASS OF WORK. ° ° : NEW DWELLING UNITS..: 1
TYPE OF USE •SF NO. OF BUILDINGS: 1
INSTALL TYPE •LTPSWR IMP'ERV SURFACE: 0 sf
Remarks: Sewer. connection for a new single family dwelling.
Owner: FEES
KEITH BAKER type amount by date recpt
4422 SW APPLETREE PLACE PRMT $ 2300.00 GEO 11/30/98 98- 311145
ALOHA OR 97007 INSP $ 35.00 GEO 11/30/98 98- 311145
Phone #: 591 -9504
Contractor:
KEITH BAKER
4422 SW APPLETREE PLACE
ALOHA OR 97007
Phone #: 591 -9504 $ 2335.00 TOTAL
Reg #••
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
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 SewerB.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 -0001 -0080. You may obtain copies of
these rules or direct questions to OUNC by cal 'ng (503)246 - 1987.
Issued by: ��_.F'ermittee Signature: , '
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Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
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