Permit CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2002 -00127
Ai DATE ISSUED: 5/1/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 12990 SW 116TH PL PARCEL: 2S103BD -09200
SUBDIVISION: HUNTER'S WOODLAND ZONING: R -4.5
BLOCK: LOT: 004 JURISDICTION: TIG
TENANT NAME:
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 permit for new SF detached residence.
Owner:
FEES
LEGACY HOMES LLC
PO BOX 446 Type By Date Amount Receipt
SHERWOOD, OR 97140 PRMT CTR 5/1/02 $2,300.00 27200200000
INSP CTR 5/1/02 $35.00 27200200000
Phone: 503 - 925 -0506 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
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" Perm
Is ued by: / . .; ( ∎at Permittee Signature:
'
Call (503) •. •-4175 by 7:00 P.M. for an inspection needed the ne business day