Permit CITY T I GA R D SEWER CONNECTION PERMIT
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DEVELOPMENT SERVICES PERMIT #: SWR2004 -00316
c4l DATE ISSUED: 12/16/2004
13125 SW Hall Blvd., Tigar OR 97223 (503) 639 -4171
SITE ADDRESS; 08062 SW LEISER LN PARCEL: 2S112BC -13400
SUBDIVISION: LEISER PARK ZONING: R - 4.5
BLOCK: LOT: 003 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: New SF sewer connection.
Owner: FEES
LEGEND HOMES
12755 SW 69TH # 100 Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connecti( 12/16/2004 $2,500.00
[SWUSA] Swr Connecti( 12/16/2004 $0.00
Phone: 503- 620 -8080 [SWINSP] Sewer Inspect 12/16/2004 $35.00
[SWINSP] Sewer Inspect 12/16/2004 $0.00
Contractor:
Total $2,535.00
Phone:
Reg #:
Required Inspections
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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 -101- 100. You
- may -obtai - s -of -these rules or direct- questions -to- OUNC -by- calling - (503) 246 -66.9.
Issued Ce.4504-4/K.I4Lif Permittee Signature: •
. Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day