Permit , .
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CITY TIGARD SEWER CONNECTION PERMIT
I � DEVELOPMENT SERVICES PERMIT #: SWR2000- 00087
�'��1 DATE ISSUED: 05/15/2000
13125 SW Hall Blvd., Tigard, OR 9.7223 (503) 639 -4171
. ' SITE ADDRESS; 15301 SW 84TH AVE PARCEL: 2S112C6 -HC009
SUBDIVISION: HAMPTON COURT ZONING: R -7 '
BLOCK: LOT: 009 JURISDICTION: TIG
TENANT NAME: LEGEND HOMES ' •
USA NO: FIXTURE UNITS: 1 '
CLASS OF WORK: NEW , DWELLING UNITS: 1
' TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR ' IMPERV SURFACE:
Remarks: Sewer connection for a new single family dwelling.
Owner: FEES
LEGEND HOMES - ,
TyPe • By Date Amount- Receipt '
12755 SW 69TH AVE
PORTLAND, OR 97223 PRMT GEO . 05/15/200C $2,300.00 0002186,
INSP GEO 05/15/200C $35.00 0002186
Phone: Total $2,335.00 -
Contractor: =
Phone:. .
Reg #:
Required Inspections
Sewer Inspection
ORtGtNAL .,
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This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. 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 -0080.
• You may obtain copies oft - rules • r direct questions to OUNC by calling (503) 246 -1987.
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Issued by: _ � �� / Permittee Signatur=`' ... \,..0
Call (50 639 -4175 by 7:00 P.M. for an inspection needed the next business day