Permit CITY TIGARD SEWER CONNECTION PERMIT
+ re. DEVELOPMENT SERVICES PERMIT #: SWR2005 -00040
E 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/14/2005
PARCEL: 2S109BA -08200
SITE ADDRESS; 13634 SW LEAH TERR ZONING: R -7
SUBDIVISION: DAFFODIL HILL LOT: 008 JURISDICTION: TIG
Project Description: Sewer connection
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTP IMPERV SURFACE:
Owner: FEES
GOODLETT MARSHALL BLDG & DEV
PO BOX 91551 Description Date Amount
PORTLAND, OR 97291 [SWUSA] Swr Connection Fee 3/14/2005 $2,500.00
[SWINSP] Sewer Inspection Fee 3/14/2005 $35.00
Phone: 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 p • : se a "Tap and Side Sewer"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires o - to fo low rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952-00141 throu•h or 952 - 001 -0100. You
may obtain copies of these rules or direct questions to OUNC by calling 503 ; - ;.99 or 1 -wI -332 -2344.
Issued Permittee Signatur. • � 4 M -f
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that b •siness day.
This permit_ card_shall_be_kept_ in_a_conspicuous_place on_the_jobsite until completion of the project.
Approved plans are required on the job site at the time of each inspection.