Permit CITY TIGARD SEWER CONNECTION PERMIT
4 r 4, DEVELOPMENT SERVICES PERMIT #: SWR2000 -00313
., 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/4/00
SITE ADDRESS; 10620 SW WALNUT ST PARCEL: 2S102BC -02005
SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: R -4.5
BLOCK: LOT: 024 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection to sewer, and payment of reimbursement district #14 fee.
Owner:
FEES •
FRISBIE, OWEN P JR AND Type By Date Amount Receipt
ROXANNE L
10620 SW WALNUT PRMT CTR 10/4/00 $2,300.00 27200000000
TIGARD, OR 97223 INSP CTR 10/4/00 $35.00 27200000000
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Set() iNSP CTioA./
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 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: �. • ice. Permittee Si natur9L �'
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business d