Permit , DEVELOPMENT OF TIGARD SEWER CONNECTION PERMIT
,I, SERVICES
PERMIT #: SWR2000 -00246
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 9/11/00
SITE ADDRESS; 13301 SW 128TH PL PARCEL: 2S104DA 02700
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 013 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: Single family residence
Owner:
FEES
JESS ALWAY INC
24300 SW STAFFORD RD Type By Date Amount Receipt
TUALATIN, OR 97062 PRMT CTR 9/11/00 $2,300.00 27200000000
INSP CTR 9/11/00 $35.00 27200000000
Phone: 781 - 4899 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agvicy. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. ' he ncy does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the murej ent, en, the installer
shall prospect 3 feet in all directions from the distance given. If not so located ) bel =inst-a11 t- • 'case a "Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires ∎ n,� t. olldw rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001- 0S „ ! - • 2- 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 24. /ii
Issued by: / / Permittee Signature: _
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne . - • a , ,