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Permit CITY TIGARD SEWER CONNECTION PERMIT .1 DEVELOPMENT SERVICES PERMIT #: SWR2005 -00004 - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/16/2005 SITE ADDRESS; 15131 SW HAZELCREST WY PARCEL: 2S109DA SR078 SUBDIVISION: SUMMIT RIDGE ZONING: R - BLOCK: LOT: 078 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: New SF sewer connection. Owner: FEES DON MORISSETTE COMMUNITIES LLC 4230 GALEWOOD ST # 100 Description Date Amount LAKE OSWEGO, OR 97035 [SWUSA] Swr Connecti< 2/16/2005 $2,500.00 [SWUSA] Swr Connecti( 2/16/2005 $0.00 Phone: 503- 387 -7538 [SWINSP] Sewer Inspeci 2/16/2005 $35.00 [SWINSP] Sewer Inspeci 2/16/2005 $0.00 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 cmay tain copies sf these rules or direct questions to OUNC by calling (503) 246 -6699. Is ued b i Permittee Si nat�re- i � _ .� /! jam' - /f Call (503) 639 -4175 by 7:00 P.M. for an inspection needed then- t business day