Permit 41111$ • CITY OF TI GARD SEWER CONNECTION PERMIT
A * b + r a DEVELOPMENT SERVICES PERMIT #: SWR2001 -00078
,44- ,�� I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - DATE ISSUED: 4/10/01
SITE ADDRESS; 13021 SW RAPTOR PL PARCEL: 2S104DA -07600
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R-4.5 •
BLOCK: LOT: 062 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: Sewer connection for new SF detached rowhouse.
Owner:
FEES
BROWNSTONE HOMES Type By Date Amount Receipt
12670 SW 68TH PKWY #200
PORTLAND, OR 97223 PRMT CTR 4/10/01 $2,300.00 27200100000
INSP CTR 4/10/01 $35.00 27200100000
Phone: 503 - 598 -7565 Total $2,335.00
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. T• a Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measure mint given, the installer
shall prospect 3 feet in all directions from the distance given. If not so located - • - taller shal • urchase a "Tap and .
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Ores •n law r- • uire you lifollow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR =52 -001 -00 0 oug • • R 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calli g (503 246.19: .
Issued by: Permittee Signatu -:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the -xt business day