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Permit i J CITY TIGARD SEWER CONNECTION PERMIT r DEVELOPMENT SERVICES PERMIT #: SWR2001 -00065 -� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/18/01 SITE ADDRESS; �� : ` ,D t0 I� PARCEL: 2S110BC -00100 SUBDIVISION: , 1 ��� ( ZONING: R -7 BLOCK: LOT: l l JURISDICTION: TIG TENANT NAME: 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 permit for new single family residence. Owner: FEES GEORGE WALL 11600 SW BULL MOUNTAIN RD Type By Date Amount Receipt TIGARD, OR 97224 PRMT CTR 4/18/01 $2,300.00 27200100000 INSP CTR 4/18/01 $35.00 27200100000 Phone: 503 - 670 -7814 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" 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 6 7 yr 7e._. Z Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the business day