Permit CITY OF TIGARD SEWER CONNECTION PERMIT
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4 141 :. PERMIT #: SWR2000 -00280
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DEVELOPMENT SERVICES DATE ISSUED: 9/14/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 15365 SW REGENT TERR. PARCEL: 2S111DA -11200
SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R -7
BLOCK: LOT: 105 JURISDICTION: TIG
TENANT NAME:
ti 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: S/F Path 1
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Owner: FEES
MATRIX DEVELOPMENT CORP Type By Date - Amount Receipt •
6900 SW HAINES ST STE 200
TIGARD, OR 97224 PRMT CTR 9/14/00 $2,300.00 27200000000
INSP CTR 9/14/00 $35.00 27200000000
Phone: 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:
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Permittee Signat e: ..Las / L� `
Call (5 3) 639 -4175 by 7:00 P.M. for an inspection needed the next busine d a y
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