Permit CITY TIGARD SEWER CONNECTION PERMIT
. l; DEVELOPMENT SERVICES PERMIT #: SWR1999 - 00248
'' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/13/99
SITE ADDRESS; 12393 SW 114TH TERR PARCEL: 2S103A6 06400
SUBDIVISION: WALNUT GLEN ZONING: R - 4.5
BLOCK: LOT: 022 JURISDICTION: TIG
TENANT NAME: RIVERSIDE HOMES
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for a new single family dwelling.
Owner:
FEES
RIVERSIDE HOMES Type By Date Amount Receipt
15455 NW GREENBRIER PKWY #140
BEAVERTON, OR 97006 PRMT DEB 12/13/99 $2,300.00 99- 320383
INSP DEB 12/13/99 $35.00 99- 320383
Phone: 645 - 0986 Total $2,335.00
Contractor:
Phone: ORIGINAL
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 C3rrgorrrlrl ility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
Yo may obtain cop`i -s of these rul- or direct questions to OUNC by calling (503) 246 -198 .
Issu by: �4 rA - / � Permittee Signature:
Call (503) 63' -4175 by 7:00 P.M. for an inspection needed the next business day
4/26/00 Activities for Case #: SWR1999 -00248
2:11:45 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA003 Application received 11/12/99 GEO RECD No Hold GEO 11/17/99
SWRA008 Permit Created 11/17/99 GEO DONE No Hold GEO 11/17/99
SWRA705 Sewer Inspection 12/22/99 MS PASS No Hold RB 12/22/99 Case Final- OK
SWRA032 DST Post - Review Completed 11/23/99 GEO DONE No Hold GEO 11/23/99
SWRA070 Ready to issue 11/23/99 GEO DONE No Hold GEO 11/23/99
SWRA080 (F) Issue permit 12/13/99 DEB DONE No Hold DEB 12/13/99
SWRA720 Case Finaled 12/27/99 AKJ DONE No Hold AKJ 12/27/99
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