Permit CITY TIGARD SEWER CONNECTION PERMIT
;Yr DEVELOPMENT SERVICES PERMIT #: SWR1999 -00229
I a 13125 SW Hall Blvd., Tigard, OR 97223 (50 PATE ISSUED: 11/02/1999
W
SITE ADDRESS; 13050 SW PACIFIC HY
V PARCEL: 2S102CB -02700
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT: 020 JURISDICTION: TIG
TENANT NAME: SANCHEZ TAQUERIA •
USA NO: FIXTURE UNITS: 10
CLASS OF WORK: ALT DWELLING UNITS: 0
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Dummy sewer permit. Originally 16 fixture values, capped 20 fixture values, new fixture value is 10,
• no change in DU's.
Owner:
FEES
Type By Date Amount Receipt
Total
Phone:
Contractor: •
Phone:
Reg #:
•
• Required Inspections
•
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 copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
•
Issued by: Permittee Signature: .
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
Accumulative Sewer Tally
Tenant Name: �1_ . . - •V . 4k� . ' (G- Taus SWR# (���' I 2-2-61 Address: • I 1. • :_ I it This PLM# 11'11 —0(7
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total .
Count off #s count value values
Baptistry/Font 4 .
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4 7 •
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 ,
Eye Wash 1 _
Floor Drain/sink - 2 inch 2 ( 1vbJtb> / 2. / 2 —
- 3 inch 5
- 4 inch 6
- Car Wash Dm 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48
Ice Machine /Refrigerator Drains 1 ,
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar/Lavatory 2
- Bradley 5
- Commercial 3 ( 3 C A ��;) CP /6 9 l aP r
- Service 3 .
•
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Urinal 6
Pet( azzcolAtA+wi t b ki, i To I 7 a p 5 !� / TOTALS I D xe • I 1p
Total fixture values: ( divided by 16 = • /-P5 EDU = / 7-t Aid '!#4 J 6 E.
HISTORY
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
i:ldsts\swrtaly.doc