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Permit A l hb CITY OF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT #: SWR1999 -00083 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/19/99 SITE ADDRESS; 14225 SW 116TH TERR PARCEL: 2S1106A -08800 SUBDIVISION: EVERGREEN SPRINGS ZONING: R -4.5 BLOCK: LOT: 013 JURISDICTION: TIG TENANT NAME: RENAISSANCE CUSTOM 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: Sewer connection for a new single family dwelling. Owner: FEES RENAISSANCE CUSTOM HOMES Type By Date Amount Receipt 1672 SW WILLAMETTE FALLS DR WEST LINN, OR 97068 PRMT DST 7/19/99 $2,300.00 99- 316963 INSP DST 7/19/99 $35.00 99- 316963 Phone: 557 -8000 Total $2,335.00 Contractor: Phone: Reg #: Required Inspections Sewer Inspection ORIGINAL 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• i ��� _ _ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day