Permit • CITY OF TI GARD SEWER CONNECTION PERMIT
DEVELOPMENT SER PERMIT #: SWR2002 - 00044
, rll� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/6/03
SITE ADDRESS; 13295 SW KINGSTON PL PARCEL: 2S104DA - 19400
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5
BLOCK: LOT: 020 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF rowhouse.
Owner:
FEES
BROWNSTONE QUAIL HOLLOW LLC Description Date Amount
12670 SW 68TH PKWY STE 200
PORTLAND, OR 97223 [SWUSA] Swr Connect 3/5/03 $2,300.00
[SWUSA] Swr Connect 3/5/03 $0.00
Phone: 503 -598 -7565 [ SWINSP] Swr Inspect 3/5/03 $35.00
[SWINSP] Swr Inspect 3/5/03 $0.00
Contractor:
Total $2,335.00
Phone:
Reg #:
Required Inspections
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.
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Issued by: Permittee Signature: gy,,, ice"/ /
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day