Permit kik CITY OF TIGARD SEWER CONNECTION PERMIT
e DEVELOPMENT SERVICES PERMIT #: SWR2000 -00319
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/10/00
SITE ADDRESS; 10625 SW WALNUT ST PARCEL: 2S103AA -01902
SUBDIVISION: COTTONWOOD PLACE ZONING: R-4.5
BLOCK: LOT: 005 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: Connect existing single family residence to newly installed sewer lateral. Septic tank must be
pumped, filled and inspected or removed.
Owner: FEES
HATANAKA, BARRY
RURIKO Type By Date Amount Receipt
10625 SW WALNUT INSP CTR 10/10/00 $35.00 27200000000
TIGARD, OR 97223 PRMT CTR 10/10/00 $2,300.00 27200000000
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
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 OAR 952 - 001 -0080.
You ma • • ain •• • ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
I
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.� / Perm ittee Signature:
Issue by: k_ !! /...l� JA L . I � g ��_
Call (50 639 -4175 by 7:00 P.M. for an inspection needed the next • usiness day