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Permit r. CITY TIGARD SEWER CONNECTION PERMIT 1lA DEVELOPMENT SERVICES PERMIT #: SWR2003 -00218 DATE ISSUED: 11/3/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS; 10820 SW BRIARWOOD PL PARCEL: 1S133AC HB012 SUBDIVISION: HAWK'S BEARD TOWNHOMES ZONING: R - 25 BLOCK: LOT: 012 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 Issued y: T` - Permittee Signature: ` o.a 4-p Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day