Permit A l CITY OF TIGARD SEWER CONNECTION PERMIT
0, DEVELOPMENT SERVICES PERMIT #: SWR2000 -00392
l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/8/01
SITE ADDRESS; 13555 SW WALNUT LN PARCEL: 2S1046D -09800
SUBDIVISION: SULLIVAN MLP2000 -00004 ZONING: R -7
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: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new single family residence.
Owner:
FEES
J P CONSTRUCTION Type By Date Amount Receipt
10275 SW GULL PL
BEAVERTON, OR 97007 PRMT CTR 1/8/01 $2,300.00 27200100000
INSP CTR 1/8/01 $35.00 27200100000
Phone: 503 - 524 -3295 Total $2,335.00
Contractor:
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Phone:
Reg #:
Required Inspections
Sewer Inspection
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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" 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 OA" 952 - 001 -0080.
You may • • - .n copies of these rules or direct questions to OUNC by calling (503) 246 -1987 /
Issued y: , Permittee Signature: 7I.`/j N1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed th Axt business day