Permit CITY TIGARD SEWER CONNECTION PERMIT
4" I DEVELOPMENT SERVICES
PERMIT #: SWR2000 -00137
.� l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/3/00
SITE ADDRESS; 13410 SW 129TH AVE PARCEL: 2S104DA -QHWO
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 018 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: PATH I S/F
Owner: FEES
Type By Date Amount Receipt
PRMT DEB 7/3/00 $2,300.00 0003419
INSP DEB 7/3/00 $35.00 0003419
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
oR\GINAL
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 ado. -d
by the Or-! : 6.1-ti[Or Notification Center. Those rules are set forth in OAR 952 - 001 -0010 t ough OAR 952 - 001 -008 %.
You m- obtain copies of these rules or direct questions to OUNC by calling (50 246 -11 o7
Issued • : /I&_1/1. Permittee Signature: AA "
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day