Permit r
TY OF ��G�RD SEWER CONNECTION PERMIT
I PERMIT #: SWR2003 -00291
yy ; � DEVELOPMENT SERVICES DATE ISSUED: 7/15/03
" 13125 SW Hall B Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 10400 SW PARK ST PARCEL: 2S102C6 -07300
SUBDIVISION: MLP97 - 0019 CHILDREN'S VILLAGE ZONING: R - 3.5
BLOCK: LOT: 001 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: IMPERV SURFACE:
Remarks: .1 EDU increase. Previous EDU = 8.3 for a fix. value of 132.8. Addition of 2 fixture
2 fixture values for current EDU of 8.4 for a increase of .1 EDU increase.
Owner: FEES
FERNANDO, ANIL NIHAL KANWAR +
ANNE ELIZABETH Description Date Amount
17549 OAK MEADOW LN [ SWUSA] Swr Connect 7/15/03 $240.00
LAKE OSWEGO, OR 97034 [SWUSA] Swr Connect 7/15/03 $0.00
Phone:
Total $240.00
Contractor:
Phone:
Reg #:
Required Inspections
•
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 9.
Issued by: P ermittee Signature: J( elas______-----
Call (503) 639 - 4175 by 7:00 P.M. for an inspection needed the n xt business day
Accumulative Sewer Tally
Tenant Nauss:, -Ci iZJren's Village This SWR$i 2003 -00291
Site Address: 10400 SW Park St. - This PLM# 2003 -00347
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
-3inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0 .
- Car Wash Drn 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 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 .1 3 1 3
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 1 1 0 -1 -1
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 8.3 132.8 132.8
Capped EDU Credit 0
TOTALS 0 132.8 1 1 1 3 0 134.8
Current Fixture Value 134.8 divided by 16 = 8.4 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 132.8 divided by 16 = 8.3 Previous EDU
Change 2 divided by 16 = 0.1 over (under) $ 240.00
- Enter EDU Change Here 0.1
HISTORY
Notes: PLM# EDU# SWR#
8.3 EDU from Jamie G. PLM# EDU# SWR#
PLM# EDU# SWR#
Name: Sf / / �/ _,/,L Date: 7— /6"—e9
Signature of person that calculated this tally sheet and date perfromed is required