Permit * 40 CITY OF TIGARD SEWER CONNECTION PERMIT
4 ' DEVELOPMENT SERVICES PERMIT #: SWR2003 -00300
'r I " ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/28/03
SITE ADDRESS; 13050 SW PACIFIC HY PARCEL: 2S102CB -02700
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SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C - G
BLOCK: LOT: 020 JURISDICTION: TIG
TENANT NAME: SANCHEZ TAGUERIA
USA NO: FIXTURE UNITS: 3
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: sewer tally.
Owner:
FEES
CAPONE, ANTHONY M
13056 SW PACIFIC HWY Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connect 7/28/03 $720.00
[SWUSA] Swr Connect 7/28/03 $0.00
Phone:
Total $720.00
Contractor:
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.
Issued by: vt:40_ ' , . _ _ // Permittee Signature: I
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
r 4. -. Accumulative Sewer Tally
Tenant Name: Sanchez Taqueria This SWRt 2003 -00300
Site Address: 13050 SW Pacific Hwy. This PLM# 2003 -00366
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Dm 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 2 4 1 2 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 1 16 16
Capped EDU Credit 0
TOTALS 0 16 2 4 _ 2 8 0 20
Current Fixture Value 20 divided by 16 = 1.3 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 16 divided by 16 = 1.0 Previous EDU
Change 4 divided by 16 = 0.3 over (under) $ 720.00
Enter EDU Change Here 0.3
HISTORY
Previous EDU =1 per water dept PLM# EDU# SWR#
PLM# EDU# SWR#
PLM# EDU# SWR#
/ --- Name: ,jr. _ , ,,_,- / _ _ , Date: f . 5 4 3
Signature of person that calculated this tally sheet and date pe rfrom d is required