Permit CITY O - F TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2002 - 00298
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/7/03
SITE ADDRESS; 14264 SW 132ND PL PARCEL: 2S109AB 09600
SUBDIVISION: RAVEN RIDGE ZONING: R -7
BLOCK: LOT: 025 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 for new SF residence.
Owner: •
FEES
DECAL CUSTOM HOMES
2345 6TH ST. Description Date Amount
COLUMBIA CITY, OR 97018 [SWUSA] Swr Connect 1/6/03 $0.00
[SWUSA] Swr Connect 1/6/03 $2,300.00
Phone: 503- 366 -0797 [SWINSP] Swr Inspect 1/6/03 $0.00
[SWINSP] Swr Inspect 1/6/03 $35.00
Contractor:
Total $2,335.00
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" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires yo - •v' • adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 • •ugh 0' 952 -00 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (50 • • n .99.
Issued by: Permittee Signa ��
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed - • - • business day