Permit v �
CITY TIGARD SEWER CONNECTION PERMIT
l& DEVELOPMENT SERVICES PERMIT #: SWR2004 -00065
c �' ll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/13/04
SITE ADDRESS; 09653 SW WASHINGTON SQUARE RD PARCEL: 1S12600-00300
SUBDIVISION: POMA- IINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS: 14
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .9 EDU Increase
Owner: FEES
PPR WASHINGTON SQUARE LLC Description THE MACERICH COMPANY escription Date Amount
9585 SW WASHINGTON SQ. RD. [SWUSA] Swr Connect 2/13/04 $2,160.00
PORTLAND, OR 97223 [SWUSA] Swr Connect 2/13/04 $0.00
Phone:
Total $2,160.00
Contractor:
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
Issued by: Permittee Signature: I
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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