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Permit CITY TIGARD SEWER CONNECTION PERMIT II DEVELOPMENT SERVICES PERMIT #: SWR2003 -00128 f Il- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/21/03 SITE ADDRESS; 14340 SW 114TH AVE PARCEL: 2S110AB -02000 SUBDIVISION: COLE'S ACRES ZONING: R -4.5 BLOCK: LOT: 007 JURISDICTION: TIG TENANT NAME: HELLER 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 connection for existing house. Septic tank is to be pumped, filled and inspected. Owner: FEES HELLER, REIDAR W JR + ARLENE RAE Description Date Amount 14340 SW 114TH AVE TIGARD, OR 97223 [SWUSA] Swr Connect 4/21/03 $2,300.00 [SWUSA] Swr Connect 4/21/03 $0.00 Phone: [SWINSP] Swr Inspect 4/21/03 $35.00 [SWINSP] Swr Inspect 4/21/03 $0.00 Contractor: Total $2,335.00 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 i Issue, by: 1 ; a /1/ Permittee Signature: 1 S A 2,, Call (503) 6 -4175 by 7:00 P.M. for an inspection needed the next business day