Permit CITY TIGARD SEWER CONNECTION PERMIT
� I� DEVELOPMENT SERVICES PERMIT #: SWR2000 - 00147
13125 SW Hall Blvd., Tigard, OR 97223 (503) 63 -4171 DATE ISSUED: 06/19/2000
SITE ADDRESS; 11492 SW LAUREL GLEN CT PARCEL: 2S110AC - L0004
SUBDIVISION: LAUREL GLEN ZONING: R - 4.5
BLOCK: LOT: 004 JURISDICTION: TIG
TENANT NAME: DON BUSS
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: ALT DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for an existing dwelling.
Owner:
FEES
DON BUSS Type By Date Amount Receipt
440 NW HILLTOP RD
PORTLAND, OR 97210 PRMT GEO 06/19/200C $2,300.00 0003098
INSP GEO 06/19/200C $35.00 0003098
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
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ORIGINAL
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 copi -: if thes- r -= or direc ■uestions -to OUNC—by (503) 246 = 1 - --
Issued by: Permittee Signatu
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Call (503) 63• , 175 by 7:00 P.M. for an inspection need d the next business day