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Permit • C ITY OF TI CARD SEWER CONNECTION PERMIT 4PERMIT #: SWR2004 -00066 � DEVELOPMENT SERVICES DATE ISSUED: 6/1/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -417 SITE ADDRESS; 09580 SW PIHAS ST PARCEL: 1S135CD -14100 SUBDIVISION: GREENBURG PINES ZONING: R - 4.5 BLOCK: LOT: 012 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: Sewer connection for new SF Owner: FEES VISTA NORTHWEST Description Date Amount PO BOX 91459 PORTLAND, OR 97291 [SWUSA] Swr Connect 6/1/2004 $2,400.00 [SWUSA] Swr Connect 6/1/2004 $0.00 Phone: 503 0531 - 0505 [SWINSP] Swr Inspect 6/1/2004 $35.00 [SWINSP] Swr Inspect 6/1/2004 $0.00 Contractor: Total $2,435.00 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 ma : • r - • :' -s of these rules or direct questions to OUNC by calling (503) 246 -6699. - ssued by: C -i Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day