Permit CITY TIGARD SEWER CONNECTION PERMIT
4.00.10 PERMIT #: SWR2004 -00333
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Ail I DEVE H BMEN r S � ERV 2CES 639 -4171 DATE ISSUED: 11/1/2004
SITE ADDRESS; 11555 SW TIEDEMAN AVE PARCEL: 1S135CB-00500
SUBDIVISION: ZONING: I -P
BLOCK: LOT: 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 SF
Owner: FEES
GABRIEL INVESTMENT LLC Description Date Amount
10250 SW NORTH DAKOTA ST
TIGARD, OR 97223 [SWUSA] Swr Connectic 11/1/2004 $2,500.00
[SWUSA] Swr Connectic 11/1/2004 $0.00
Phone: [SWINSP] Sewer Inspect 11/1/2004 $35.00
[SWINSP] Sewer Inspect 11/1/2004 $0.00
Contractor:
Total $2,535.00
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 yo : -foil• • -s adopted by the
Oreg. - • i i y , : Center. Those rules are set forth in OAR 952 - 001 -0010 througr �� A " ° 52- 001 -0100. You
ma, obtain copies o ese rules . - ctquestionsto OUNC by calling (503) 246 .• 699.
Iss . - d by: _ :rz � If ,/ _ -
Permittee Signature: At ��idk
Call (503) 639 • by 7 :00 P.M. for an inspection needed the ne , • ay