Permit 1 1
CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2003 -00214
DATE ISSUED: 11/3/03
' "---'' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 10855 SW 130TH AVE PARCEL: 1S133AC-HBOO8
SUBDIVISION: HAWK'S BEARD TOWNHOMES ZONING: R - 25
BLOCK: LOT: 008 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 dwelling.
Owner: FEES
AUTUMN PARK TOWNHOMES, LLC Description Date Amount
9500 SW BARBUR BLVD., STE 220 .
PORTLAND, OR 97219 [SWUSA] Swr Connect 11/3/03 $2,400.00
[ SWUSA] Swr Connect 11/3/03 $0.00
Phone: 503- 892 -8758 [SWINSP] Swr Inspect 11/3/03 $35.00
[SWINSP] Swr Inspect 11/3/03 $0.00
Contractor:
Total $2,435.00
Phone:
Reg #:
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" Perm
Issue by: �/ ,, 44; Permittee Signature: ACC ldp
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day