Permit A k CITY OF TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2002 -00297
A DEVELOPMENT SERVICES DATE ISSUED: 1/6/03
13125 SW Hal Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 13101 SW ST. JAMES LN PARCEL: 2S109AB -07300
SUBDIVISION: RAVEN RIDGE ZONING: R -
BLOCK: LOT: 002 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: Sewer connection for new SF residence.
Owner:
FEES
DECAL CUSTOM HOMES
2345 6TH ST. Description Date Amount
COLUMBIA CITY, OR 97018 [SWUSA] Swr Connect 1/6/03 $0.00
[SWUSA] Swr Connect 1/6/03 $2,300.00
Phone: 503 366 - 0797 [SWINSP] Swr Inspect 1/6/03 $0.00
[SWINSP] Swr Inspect 1/6/03 $35.00
Contractor:
Total $2,335.00
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
Issued by: -'/ � A O, , _ _ Permittee Sig 40
`� -A_
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t e next business day