Permit CITY OF TI GARD SEWER CONNECTION PERMIT
A DEVE LOPMENT SERVICES PERMIT #: SWR2004 -00325
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/29/2004
SITE ADDRESS; 14406 SW PENNYWORT TERR PARCEL: 2S112BA -BT026
SUBDIVISION: BONITA TOWNHOMES ZONING: R - 12
BLOCK: LOT: 026 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: New SFA sewer connection.
Owner: FEES
JLS CUSTOM HOMES
16280 NW BETHANY Description Date Amount
BEAVERTON, OR 97006 [SWUSA] Swr Connectic 11/29/2004 $2,500.00
[SWUSA] Swr Connectic 11/29/2004 $0.00
Phone: 503 -533 -4006 [ SWINSP] Sewer Inspect 11/29/2004 $35.00
[SWINSP] Sewer Inspect 11/29/2004 $0.00
Contractor:
Total $2,535.00
Phone:
Reg #: LIC 139970
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"
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.
Issue y: LD ___ ____ Permittee Signature: eir--4.
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day