Permit A . _ CITY OF TI GARD SEWER CONNECTION PERMIT
A '1 1 101 - DEVELOPMENT SERVICES PERMIT #: SWR2000 - 00020
` - - '1' 13125 13125 SW Hall Blvd., T igard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/13/2000
SITE ADDRESS; 12262 SW 114TH TERR PARCEL: 2S103AB - 05000
SUBDIVISION: WALNUT GLEN O ^ K � ^ (G � NAL ISDICTIOI ZONING: R - 4.5
BLOCK: LOT: 008 : TIG
TENANT NAME: RIVERSIDE HOMES
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: New SF - Path 1
Owner: FEES
RIVERSIDE HOMES Type By Date Amount Receipt
15455 NW GREENBRIER PKWY
#140 PRMT KJP 06/13/200C $2,300.00 0002939
BEAVERTON, OR 97006 INSP KJP 06/13/200C $35.00 0002939
Phone: 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 Notifi -tion Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtain copi s • • -se rules or direct questions to OUNC by calling (503) 246 - 1987.
Issued by: ,__) at7 Permittee Signature: A'
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day