Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
�� DEVELOPMENT SERVICES DATE ISSUED: 5/6/02
1� PERMIT #: SWR2002 -00019
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 13005 SW ST JAMES LN PARCEL: 2S109AB -07700
SUBDIVISION: RAVEN RIDGE ZONING: R -7
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: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new single family detached residence.
Owner:
FEES
JAMES SHULTZ
22723 WEST PLUSS CT Type By Date Amount Receipt
WEST LINN, OR 97068 PRMT CTR 5/6/02 $2,300.00 27200200000
INSP CTR 5/6/02 $35.00 27200200000
Phone: 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" Perm
Iss ed by: &•,;I ,I ' / / /i Permittee Signature: r
Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business day