Permit • CITY OF TIGARD SEWER CONNECTION PERMIT
04 I DEVELOPMENT SERVICES PERMIT #: SWR2004 -00098
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/21/04
SITE ADDRESS; 14179 SW WALNUT LN PARCEL: 2S1046C -BW006
SUBDIVISION: BAILEY WOODS ZONING: R -
BLOCK: LOT: 006 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
Owner: FEES
BUENA VISTA CUSTOM HOMES
6932 SW MACADAM STE C Description Date Amount
PORTLAND, OR 97219 [SWUSA] Swr Connect 4/21/04 $2,400.00
[SWUSA] Swr Connect 4/21/04 $0.00
Phone: 503- 443 -6033 [SWINSP] Swr Inspect 4/21/04 $35.00
[SWINSP] Swr Inspect 4/21/04 $0.00
Contractor:
Total $2,435.00
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
6 0(6 4 /, Issu d by: -�Permittee Signature: L,
Call (503) • 9-4175 by 7:00 P.M. for an inspection needed the next / siness day