Permit ‘ 41 4 , CITY OF TIGARD SEWER CONNECTION PERMIT
I DEVELOPMENT SERVICES PERMIT #: SWR2001 -00269
�r>♦l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/3/01
SITE ADDRESS; 13499 SW 129TH AVE PARCEL: 2S104DA 03800
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 024 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 fee for new single family.
Owner: FEES
STEVEN PRINCE HOMES INC
13410 SW 129TH AVE Type By Date Amount Receipt
TIGARD, OR 97223 PRMT CTR 10/3/01 $2,300.00 27200100000
1NSP CTR 10/3/01 $35.00 27200100000
Phone: 503 - 579 -3051 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 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 : • - Sewer" Perm
Issued by: Permittee Signature \4
/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day