Permit a
Alb CITY OF T I GA R D SEWER CONNECTION PERMIT
��;� DEVELOPMENT SERVICES
PERMIT #: SWR2005 -00166
'- I- ' 13125 SW Hall Blvd., Tigard, O R 97223 503 - 639 -4171 DATE ISSUED: 6/22/2005
PARCEL: 2S 109AD -AS002
SITE ADDRESS: 12837 SW WINTERVIEW DR ZONING: R -
SUBDIVISION: ARBOR SUMMIT LOT: 002 JURISDICTION: TIG
Project Description: New SF sewer connection.
S
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:
FEES
WEST HILLS DEVELOPMENT
15500 SW JAY ST Description Date Amount
BEAVERTON, OR 97006 [SWUSA] Swr Connection Fee 6/22/2005 $2,500.00
[SWINSP] Sewer Inspection Fee 6/22/2005 $35.00
Phone: 503 - 641 - 7342 Total $2,535.00
Contractor:
REQUIRED ITEMS AND REPORTS
Phone:
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. ■
Issued by: Permittee Signature: _ ' A i __
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that . , s i ness day.
This permit card shall be kept in a conspicuous place on the job site until completio of the project.
Approved plans are required on the job site at the time of each inspection.