Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2001 -00232
�,�� DEVELOPMENT SERVICES DATE ISSUED: 9/4/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 13088 SW ST. JAMES LN PARCEL: 2S109A6 -10900
SUBDIVISION: RAVEN RIDGE ZONING: R -7
BLOCK: LOT: 038 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
CHARLES KIM
16655 SW IVY GLENN ST. Type By Date Amount Receipt
BEAVERTON, OR 97007 PRMT CTR 9/4/01 $2,300.00 27200100000
INSP CTR 9/4/01 $35.00 27200100000
Phone: 503 - 515 -6011 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" Perm
—
Issued by: . . ; , � �, �� i� . Permittee Signature: .i a /
Call (503) 63 • -4175 by 7:00 P.M. for an inspection needed the next business day