Permit I CITY OF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
PERMIT
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-. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # ° SW R99 - 0004
DATE ISSUED: 01/19/99
• PARCEL: 1S135AD -05500
SITE ADDRESS..° :10760 SW SITKA ST
SUBDIVISION -TRENT TERRACE ZONING: R -12
BLOCK.......... LOT :005 JURISDICTION:
TENANT NAME ° KIMCO PROPERTIES LTD
USA NO...........: FIXTURE UNITS...: 0
CLASS OF WORK... :NEW DWELLING UNITS..: 1
TYPE OF USE -SF NO. OF BUILDINGS 1
INSTALL TYPE °LTPSWR IMPERV SURFACE: 0 sf
Remarks: Sewer connection for a new single family dwelling.
Owner: FEES
KIMCO PROPERTIES LTD type amount by date recpt
22060 SE 442ND AVE PRMT $ 2300.00 JSD 01/19/99 99-312277
SANDY OR 97055 INSP $ 35°00 JSD 01/19/99 99- 312277
Phone ##:
Contractor: —
OWNER
Phone #: $ 2335.00 TOTAL
Reg 44..
REQUIRED INSPECTIONS
This Applicant agrees to cooply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The peroit expires 180 days froo
the date issued. The total mount paid will be forfeited if the
peroit expires. The Agency does not guarantee the accuracy of the _
side sewer laterals. If the sewer is not located at the oeasureoent _ __
given, the installer shall prospect 3 feet in all directions froo
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer" Peroit 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 CAR
952- %1 -0 010 through OAR 952 -0001 -0080. You oay obtain copies of
these rules or direct questions , WUNC by calling (50 '. -1987. __
..411004" ,
Issued by: .:g Permittee Signature :I_ /
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Call 639 -4175 by 7 :00 p.m. for an inspection needed the next business day
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