Permit CITY OF T.IGARD
- DEVELOPMENT SERVICES PERMIT
PERMIT SEWER CONNECTION ECTION -00021
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 02/25/2000
SITE ADDRESS; 13110 SW WELLINGTON PL PARCEL: 2S104DB -03400
SUBDIVISION: AMESBURY HEIGHTS ZONING: R -4.5
BLOCK: LOT: 034 JURISDICTION: TIG
TENANT NAME: MCWHIRTER
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: Sewer connection for new single family residence.
Owner:
FEES
J MICHAEL MCWHIRTER Type By Date Amount Receipt
25570 SW LABROUSSE RD
SHERWOOD, OR 97140 PRMT GEO 02/25/200C $2,300.00 00- 321860
INSP GEO 02/25/200C $35.00 00- 321860
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
• Sewer Inspection
•
ORIGINAL
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 thes- rules or • irect questions to OUNC by calling (503) 246 -1987.
/ . '
Issued by: -� � Permittee Signature. � /�I
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed -'ext business day