Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 -00161
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/29/2007
PARCEL: 2S 102DC -00510
SITE ADDRESS: 09115 SW EDGEWOOD ST ZONING: R - 4.5
SUBDIVISION: EDGEWOOD LOT: 013 JURISDICTION: TIG
PROJECT: LARSEN
Project Description: Connect existing house to sewer service. Reimbursement District #31 fee paid this date.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
PAUL & LORI LARSEN
9115 SW EDGEWOOD ST Description Date Amount
TIGARD, OR 97224
[SWUSA] Sewer Connection Fee 6/29/2007 $2,700.00
[SWINSP] Sewer Inspection Fee 6/29/2007 $35.00
Phone: 503- 6639 -6325 Total $2,735.00
Contractor:
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
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 you to follow
rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may
obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued • : I Permittee Signature: �� /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.