Permit T „, CITY OF TIGARD
, „ ,,, DEV ELOPMENT SERVICES SEWER CONNECTION
1)) l PERMIT
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # - SW R97 -0264
DATE ISSUED: 07/02/97
PARCEL: 2S103DA -05400
SITE ADDRESS...:13395 SW 107TH AVE
SUBDIVISION.....: ZONING: R-3.5
BLOCK LOT - JURISDICTION: TIG
TENANT NAME.....:DEAN TABERT
USA NO - FIXTURE UNITS...: 0
CLASS OF WORK...: ALT DWELLING UNITS..: 1
TYPE OF USE -SF N0. OF BUILDINGS: 0
INSTALL TYPE - LTPSWR IMPERV SURFACE: 0 sf
Remarks: Installing sewer line
1 Owner: -• FEES
DEAN TABERT type amount by date recpt
13395 SW 107TH AVE PRMT $ 2200.00 B 07/02/97 97- 296730
TIGARD OR 97223 INSP $ 35.00 B 07/02/97 97- 296730
Phone #: .
Contract or:
OWNER
Phone #: $ 2235.00 TOTAL
Reg #...
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the.rules and regulations Sewer Inspection
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 -Y.1 -0010 through OAR 952- V.1 -0080. You may obtain copies of
these rules or direct questions to I�1NC by calling (503)246 -1987.
/ i// .
Issued by: ; ij4 t /�. • ii. ..1</ _ . Permittee. S.ignature: •w __
++++++++++++++++++++++++++++++++++++++++++++++++- + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•
6/6/00 Activities for Case #: SWR97 -00264
2:03:01 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA003 Application received 7/2/97 7/2/97 B PASS BON 7/2/97
SWRA008 Permit Created 7/2/97 7/2/97 B PASS BON 7/2/97
SWRA705 Sewer Inspection 7/2/97 7/2/97 ? J'H 7/18/97
SWRA080 (F) Issue permit 7/2/97 B PASS BON 7/2/97
SWRA705 Sewer Inspection 7/8/97 MS PASS J *H 7/18/97 Call back on fill.
SWRA710 Septic Tank Filled 5/21/99 GS PASS No Hold GES 5/21/99
SWRA710 Septic Tank Filled No Hold GES 5/21/99
SWRA720 Case Finaled 4/3/00 AKJ DONE No Hold AKJ 4/3/00 inspected and•filled
•
•
•
Page 1 of 1 •