Permit CITY TIGARD SEWER CONNECTION PERMIT
A DEVELOPMENT SERVICES PERMIT #: SWR2003 -00281
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/7/03
SITE ADDRESS; 14835 SW 103RD AVE PARCEL: 2S111CB 00400
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R - 3.5
BLOCK: LOT: 003 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connect existing house to sewer lateral. Septic is to be pumped, filled and inspected.
Owner:
FEES
MCNIERNEY, CHRIS & LISA
14835 SW 103RD AVE Description Date Amount
TIGARD, OR 97224 [SWUSA] Swr Connect 7/7/03 $2,400.00
[ SWUSA] Swr Connect 7/7/03 $0.00
Phone: [SWINSP] Swr Inspect 7/7/03 $35.00
[ SWINSP] Swr Inspect 7/7/03 $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
/A
Is ued by: , • � Ark 1/ , Permittee Signature: C
_
Call (50 639 -4175 by 7:00 P.M. for an inspection needed tt a next business day