Permit CITY TIGARD SEWER CONNECTION PERMIT
� DEVELOPMENT SERVICES PERMIT #: SWR2002 -00223
''�'` - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/1/02
SITE ADDRESS; 15087 SW 107TH TERR PARCEL: 2S110DA -08500
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 046 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: Sewer permit for new SF
Owner: FEES
RENAISSANCE CUSTOM HOMES Type By Date Amount Receipt
1672 SW WILLAMETTE FALLS DR
WEST LINN, OR 97068 PRMT CTR 8/1/02 $2,300.00 27200200000
INSP CTR 8/1/02 $35.00 27200200000
Phone: 503 - 557 -8000 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
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 S-wer" Perm
i
7 4 Issued by: .mot— O Permittee Signature: A . ,6
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the n business d �,"
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