Permit CITY TIGARD SEWER CONNECTION PERMIT
�I� DEVELOPMENT SERVICES PERMIT #: SWR2000 - 00353
�• I DATE ISSUED: 11/28/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 10810 SW KABLE ST PARCEL: 2S110DA 04300
SUBDIVISION: ERICKSON HEIGHTS ZONING: R - 3.5
BLOCK: LOT: 004 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 detached.
Owner:
FEES
RENAISSANCE HOMES Type By Date Amount Receipt
1672 SW WILLAMETTE FALLS DR
WEST LINN, OR 97068 PRMT CTR 11/28/00 $2,300.00 27200000000
INSP CTR 11/28/00 $35.00 27200000000
Phone: 503 - 969 - 3562 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. 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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by:, Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day