Permit !p CITY OF TIGARD
SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00276
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/7/2007
PARCEL: 2 S 104 B B -09300
SITE ADDRESS: 14199 SW WALNUT CREEK WY ZONING: R - 25
SUBDIVISION: WALNUT CREEK LOT: 010 JURISDICTION: TIG
PROJECT: WALNUT CREEK
Project Description: Sewer connection for new SF
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:
LEGEND HOMES FEES
12755 SW 69TH AVE STE #100 Description Date Amount
PORTLAND, OR 97223
[SWUSA] Sewer Connection Fee 12/7/2007 $2,800.00
[SWINSP] Sewer Inspection Fee 12/7/2007 $35.00
Phone: 503 - 620 -8080
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 qu- stions to O NC b a ling_503.246.6699
or 1 800.332.2344.
Issued by. / /// Permittee Signature: al 1, � . `L , , , As k
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Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the pro -ct.
Approved plans are required on the job site at the time of each inspection. ,