Permit � , CITY OF T I G A r �� L SEWER CONNECTION PERMIT
PERMIT # SWR000 -00163
t'li DEVELOPMENT H BMEN9 S OR R 9722 ( 3 (503) 639 -4171 DATE ISSUED: 6/28/00
SITE ADDRESS; 12189 SW QUAIL CREEK LN PARCEL: 2S103CB -11100
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 069 JURISDICTION: TIG
TENANT NAME: •
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks:
Owner: FEES •
DON MORISSETTE HOMES Type By Date Amount Receipt
4230 SW GALEWOOD ST
STE 100 PRMT DST 6/28/00 $2,300.00 00033317
LAKE OSWEGO, OR 97035 INSP DST 6/28/00 $35.00 00033317
Phone: 503 - 387 -7538 Total $2,335.00
Contractor:
Phone:
Reg #:
• Required Inspections
Sewer Inspection
•
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 neede. e next business day
•