Permit . . CITY OF TIGARD SEWER CONNECTION PERMIT
Az;. tl4 �,, 1. DEVELOPMENT SERVICES PERMIT #: SWR2001 -00172
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/16/01
SITE ADDRESS; 12025 SW ROSE VISTA DR PARCEL: 2S103CC -01100
SUBDIVISION: COLONIAL VIEW ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: TIG
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: Connect existing house to newly installed sewer lateral. Septic tank must be pumped, filled and
inspected.
Owner:
FEES
HUFFMAN, DAVID S +
CRYSTAL F Type By Date Amount Receipt
12025 SW ROSE VISTA DR PRMT BLD 5/16/01 $2,300.00 JE #232
TIGARD, OR 97223 INSP BLD 5/16/01 $35.00 JE #232
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
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 obta' I •• pies of these rules or direct questions to OUNC by calling (503) 246 -19 ;7.
Issued y: i ' , i , i Permittee Signature: `S,_ /l� _
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next businesi