Permit CITY OF TIGARD SEWER CONNECTION PERMIT
IN ° `` COMMUNITY DEVELOPMENT PERMIT #: SWR2007 -00210
TIGARD DATE ISSUED: 8/23/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103BC - 00700
SITE ADDRESS: 12220 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: MASON PARTITION LOT: JURISDICTION: TIG
PROJECT: MASON PARTITION
Project Description: Connect existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement
District #18 fee paid this date.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
JON & KARI MASON FEES
12220 SW WALNUT ST Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 8/23/2007 $2,800.00
[SWINSP] Sewer Inspection Fee 8/23/2007 $35.00
Phone:
Total $2,835.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
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" 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 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1 800 332 2344
Iss ed b l '/ I , /
y ' . _ . 1LL ,n/ t Permiftee Signature: ,f/ /j-
Call 503.639.4175 by 7:00 a.m. for an inspecti• th• business day.
This permit card shall be kept in a conspicuous place on the • •b • e until completion oft e project.
Approved plans are required on the job site at t t' • of each inspection.