Permit CITY OF TIGARD
SEWER CONNECTION PERMIT
4 �I DEVELOPMENT SERVICES PERMIT #: SWR2000 -00320
'` - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/6/00
SITE ADDRESS; 12955 SW 113TH PL PARCEL: 2S103AC -07000
SUBDIVISION: FONNER WOODS ZONING: R -4.5
BLOCK: LOT: 006 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: Sewer connection permit for new single family residence.
Owner:
FEES
CROWN CONSTRUCTION LLC Type By Date Amount Receipt
8835 SW CANYON LANE #408
PORTLAND, OR 97335 PRMT CTR 11/6/00 $2,300.00 27200000000
INSP CTR 11/6/00 $35.00 27200000000
Phone: 503 - 254 -6292 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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 of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued by: Permittee Signatur ? , q
Call 503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day