Permit CITY OF TIGARD
SEWER CONNECTION PERMIT
i1• I� DEVELOPMENT SERVICES PERMIT #: SWR2005 -00019
°`'' �:�I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/23/2005
SITE ADDRESS; 13622 SW LEAH TERR PARCEL: 2S109BA -08300
SUBDIVISION: DAFFODIL HILL ZONING: R -
BLOCK: LOT: 009 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: Sewer connection for new SF
Owner: FEES
GOODLET /MARS HALL
PO BOX 91551 Description Date Amount
PORTLAND, OR 97291 -0551 [SWUSA] Swr Connectic 2/23/2005 $2,500.00
[SWUSA] Swr Connectic 2/23/2005 $0.00
Phone: 503- 297 -1881 [ SWINSP] Sewer Inspeci 2/23/2005 $35.00
[SWINSP] Sewer Inspect 2/23/2005 $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 purr a "Tap and Side Sewer"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you t• follow rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 rough •A' •52- 001 -0100. You
- - may- obtain copies of these rules or direct - questions-to - OUNC -by calling (503) 246 .6.9.
Issued by: Permittee Signatu -: � �' `
• Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the n =xt b • siness day