Permit CITY TI GARD SEWER CONNECTION PERMIT
,
'il DEVELOPMENT SERVICES PERMIT #: SWR2003 -00224
III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/6/03
SITE ADDRESS; 13690 SW 124TH AVE PARCEL: 2S103CC -06900
SUBDIVISION: WHISTLER'S WALK ZONING: R - 4.5
BLOCK: LOT: 016 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 for new SF
Owner: FEES
DON MORISSETTE HOMES
4230 GALEWOOD STE #100 Description Date Amount
LAKE OSWEGO, OR 97035 [SWUSA] Swr Connect 8/6/03 $2,400.00
[SWUSA] Swr Connect 8/6/03 $0.00
Phone: 503- 387 -7538 [SWINSP] Swr Inspect 8/6/03 $35.00
[SWINSP] Swr Inspect 8/6/03 $0.00
Contractor:
Total $2,435.00
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. 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
Issued by: „1.0", �i ,= � �/ Permittee Signature: ,p/�, 4A1V4V
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day