Permit •
CITY TIGARD SEWER CONNECTION PERMIT
PERMIT #: Z00300009
DEVELOPMENT SERVICES DATE ISSUED: 3/03
` 13125 S W Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 11380 SW SUZANNE CT PARCEL: 1S134DC -12100
SUBDIVISION: CASCADIAN PLACE ZONING: R - 4.5
BLOCK: LOT: 010 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
. KEYSTONE DEVEOPMENT INC.
PO BOX 476 Description Date Amount
LAKE OSWEGO, OR 97034 • [ SWUSA] Swr Connect 3/4/03 $2,300.00
[SWUSA] Swr Connect 3/4/03 $0.00
Phone: 503- 635 -4736 [SWINSP] Swr Inspect 3/4/03 $35.00
[SWINSP] Swr Inspect 3/4/03 $0.00
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" 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 GAR 952 - 001 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issued by: �il i . AP_ Permittee Signature: 40
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t e next busi ess day