Permit CITY TIGARD SEWER CONNECTION PERMIT
,i 1, DEVELOPMENT SERVICES PERMIT #: SWR2000 -00242
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/15/00
SITE ADDRESS; 14870 SW 104TH AVE PARCEL: 2S111 CB -01303
SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R -3.5
BLOCK: LOT: 017 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection of existing house to newly installed sewer lateral. Reimbursement fee paid on 8/15/00,
receipt #0004503. Septic tank must be pumped, filled or removed and inspected for proper
abandonment.
Owner: FEES
DEVERS, JAMES R + SUSAN M
14870 SW 104TH AVE Type By Date Amount Receipt
TIGARD, OR 97224 PRMT DEB 8/15/00 $2,300.00 0004503
INSP DEB 8/15/00 $35.00 0004503
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
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 m o tarn cgpies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issu d by: �fiet.41(411d Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne business day