Permit CITY TIGARD SEWER CONNECTION PERMIT
kt DEVELOPMENT SERVICES PERMIT #: SWR2003 -00176
DATE ISSUED: 8/15/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
3 PARCEL: 2S105DA -16700
SITE ADDRESS; NAHCOTTA DR
SUBDIVISION: PACIFIC CREST ZONING: R -
BLOCK: LOT: 055 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF.
Owner: FEES
D R HORTON INC - PORTLAND Description Date Amount
4386 SW MACADAM AVE #102
PORTLAND, OR 97239 [SWINSP] Swr Inspect 8/15/03 $35.00
[SWINSP] Swr Inspect 8/15/03 $0.00
Phone: 503- 222 -4151 [SWUSA] Swr Connect 8/15/03 $2,400.00
[SWUSA] Swr Connect 8/15/03 $0.00
Contractor:
Total $2,435.00
Phone:
Reg #:
Required Inspections
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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 throug •AR 952 - 001 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issued by: ` / � � /� Permittee Signature: 11 ,
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Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day