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Permit C ITY OF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT #. SWR2005 -00180 ;drift DATE ISSUED: 6/10/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103AD -00507 SITE ADDRESS; 11180 SW ERROL ST ZONING: R - 5 SUBDIVISION. ECHO HEIGHTS LOT. 010 JURISDICTION. TIG Project Description: New sewer connection TENANT NAME: CWS NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 0 TYPE OF USE. SF NO. OF BUILDINGS• INSTALL TYPE. BUSWR IMPERV SURFACE: Owner: FEES MEEKER, TIM JANE A 11180 SW ERROL ST Description Date Amount TIGARD, OR 97223 [SWUSA] Swr Connection Fee 6/10/2005 $2,500 00 [SWINSP] Sewer Inspection Fee 6/10/2005 $35 00 Phone. Total $2,535.00 Contractor: REQUIRED ITEMS AND REPORTS Phone: 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 by: 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. ALOHA SANITARY SERVICE . INVOICE NO. 8600 SW Hillsboro Hwy., Hillsboro, OR 97123 9 6 8 6 503- 644 -2797 a 503 - 648 -6254 • 503 - 639 -5188 NAME: -iii '' ����' ADDRESS: i J ,Ali 4,41 , r STATE: G' �"� ZIP. C ITY: _. ./,...4 e WORK: CELL: HOME: �_ P.O. #: JOB SrTE: { _s CHEC A CASH LI CREDIT CARD ❑ PAID BY CHARGE LI AMOUNT DATE g. la -6 DRIVE e�L _ ` ❑ LINE OPENING - ❑ INSPECTION FEE � CI SERVICE CALL / ❑ LABOR, LOCATING, DIGGING, BACKFlLL LI _ MATERIAL Ma TOTAL $ THIS IS NOT A SEP IC SYSTEM INSPECTION REPORT - - �' - REMARKS /a' — TYPE OF TANK: 1 . TEEL U CONCRETE ❑ PLA IC LI HOMEMADE ❑ HORIZONTAL LI V TICAL ❑ CTANGLE ❑ ❑ OTHER SIZE OF TANK: 350 ❑ 500 ❑ 0 ❑ 110 ❑ 1250 ❑ TO ❑2000 ❑ 3000 ❑ LI LID LOCATION: INLET ❑ OUTLET-ND TANK CONDITION: GOOD LI FAIR LI POOR ❑ FITTINGS: BAFFLES LI CONC S CAST IRON LI PLASTIC LI NEEDS NEW LID? YES ❑ SIZ GROUND COVER OVER TANK COMMENTS ON CONDITION OF DRAIN LD ETC. if .1 A ,/"' .W L iL L ' I Y I I BATE4ye) -as SIGNED BY ,, • - ---*- -, :'- • - - . . . , 0 t • • ' " •• t — : : ' - ; . 0 , ' • ' ' ; • . . . -- ", . : ..-14.11,...< •"` IC dr ..- ' - .' -.-- - -- ' ."."',,-: - n.. * ' - ' . .- : '' - '-'ef - .': ••-, -- f' --- - ' a • - - i f. - • -- • -• - .,,i,•-• -. • t •,.... . - _.'"' .. '.......‘',-,,',.. 4" - - , 4 . .. fi . .,.1.' '• .. . - . S.I. • • . •-. ' • / ii.:::' ' ';', 'fi• ' t - - . 1 •- • . -- , . . .— - . • ...- • - -. )1. 1 i • 4.1r ' ' .. . .,.-.' .-: ,..,- - - • . - , . _....., , --.,.." .. _ :. • - - - " • _.:-, ..... . . . . _ ... • •, ■ . -.. ' ... ,. . • ' .r. - ,, - - r •.‘. , 1 ... • .. • • • '.. '.7.''','*:` . • .- - 1 - . , .. , . .. s _ ' - . ....-3 . . --• . '• '' .. . ::: \ '' ' 1 -) • ,.. -..- . ,4 - . . 116 ..' t If . . I' , , " ' : r , .. ' ," ..,`. • ".' t .,'' ,,'• -; ' . , : ' ‘'''' , • .. - .. ' . " - ::' ' ' .. .:"..1 2 . 7 :-.- . ' . ' ' . - ' . . • • . ,. . ' - 1'• '''• 'N " 'e l •• • ,'• . ." . . • . , . . • • . ` -•.-'• .•. . , -, . • • . • -- . • . . . . •- . • t , . - . ' " ' , ' .. • " . - , • -. . . .. , •• '' t. , '''''''' 1"' - . , .. . . ''' . .... ,.;"-., . .. . , . ,..•. , - t--..4...-;,...7 . ,..' ..: ... -;'''."4 .. _ ,. ..... . - , . •;-- • . • -__. . - , . . ... . : \ ,' • ,- .. • . . - _ • ,, „. . ., , ,. ... . '''' ''''I`ti"' .. ' ' _ i - ., t--.- -.!-.- /,..., ' . •....t- ' t, - ---- . '•-, :..t .. - - • .. , - - • '---.. , t , `, ••••„. — s ...‘ . '"..: 4 --C-----.:,‘ ... - . -.— f ..-- ' ' . '-'' • '' 11 % .... r . f . .. , .. . ,,,,,t,, . ■•• ‘.--..".. -v ■ - ' - ' ' " ..-.1.- ---..- — — •Ni" • • "",• . " '''' "" ''' . . '. . - 0 -"•'"' 1 1 r - - . ... . . . , ... -‘,.- -- . .., , . _ . - . .. ....,..-' , ,-9,- •. , , .-- ,-,.- z.-rkirt•-` , ..--ke. , , 1/4., • - . • - . . ,-..,,,_ . ,. --- - ". , i Is ' ' — i* . , . ''.-- , ' is ' 1 , .. • - „,...4.,• - - - . •.,•'--, • - ,,-. ---. ' - y "-* , -'t,' .,'' • . - ., • i ,... d , ' , 7 • ' , g A 4'.4 r , , - 4 i i; '.„ I,,... . 1., . , ... . , s. i ''''' - t ' -• :' i'itt.',: i -., , .::i .. I ._ ,, .,-- 'r; - _ ., 4 7 --:••,-,.. .t... ... 1