Permit CITY TI GA R D SEWER CONNECTION PERMIT
II DEVELOPMENT SERVICES PERMIT #: SWR2004 -00294
+L " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/17/2005
SITE ADDRESS; 07844 SW DUNE GRASS LN PARCEL: 2S1126A -10000
SUBDIVISION: BONITA TOWNHOMES ZONING: R - 12
BLOCK: LOT: 036 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SFA
Owner: FEES
JLS CUSTOM HOMES
16280 NW BETHANY Description Date Amount
BEAVERTON, OR 97006 [SWUSA] Swr Connectic 2/17/2005 $2,500.00
[ SWUSA] Swr Connectic 2/17/2005 $0.00
Phone: 503 -533 -4006 [SWINSP] Sewer Inspect 2/17/2005 $35.00
[SWINSP] Sewer Inspect 2/17/2005 $0.00
Total $2,535.00
Contractor:
REQUIRED ITEMS AND REPORTS
Phone:
Reg #: LIC 139970
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 -1100. You
may obtain copies pf these rules or direct questions to OUNC by calling (503) 246 -6699 /
Issued by:„ /L/�� /�� Permittee Signature: itkL01,1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day