Permit p .
• CITY OF TIGARD SEWER CONNECTION PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: SWR2008 -00106
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/1/2008
PARCEL: 2S103DC - 00816
SITE ADDRESS: 11265 SW FAIRHAVEN ST ZONING' R -3 5
SUBDIVISION: VIRGINIA ACRES NO. 2 LOT: 018 JURISDICTION: TIG
PROJECT: MCCOLL
Project Description: Connect existing house to sewer service Reimbursement Distict #38 fee paid
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS. 1 0
TYPE OF USE SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE'
Owner.
LEE & NANC MCCOLL FEES
11265 SW FAIRHAVEN Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 71112008 $3,100 00
[SWINSP] Sewer Inspection Fee 7/1/2008 $35 00
Phone:
Total $3,135.00
Contractor
Contact #: REQUIRED ITEMS AND REPORTS
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
Issue by. J ,,�j Permittee Signature: X / 7641y cd C: rp y
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