Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
I�", DEVELOPMENT SERVICES PERMIT #: SWR2003 -00238
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/23/2003
SITE ADDRESS; 10835 SW BRIARWOOD PL PARCEL: 1S133AC -HB034
SUBDIVISION: HAWK'S BEARD TOWNHOMES ZONING: R - 25
BLOCK: LOT: 034 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 12/23/200c $2,400.00
[SWUSA] Swr Connect 12/23/200: $0.00
Phone: 503- 892 -8758 [SWINSP] Swr Inspect 12/23/200; $35.00
[SWINSP] Swr Inspect 12/23/200; $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"
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.
Issued by: /j 7` Permittee Signature:
CaII (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day