Permit •
A li4/ CITY OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2003 -00050
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/10/03
SITE ADDRESS; 11375 SW SUZANNE CT PARCEL: 1S134DC -12000
SUBDIVISION: CASCADIAN PLACE ZONING: R - 4.5
BLOCK: LOT: 009 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 dwelling.
Owner:
FEES
KEYSTONE DEVEOPMENT INC.
PO BOX 476 Description Date Amount
LAKE OSWEGO, OR 97034 [SWUSA] Swr Connect 4/10/03 $2,300.00
[SWUSA] Swr Connect 4/10/03 $0.00
Phone: 503 635 - 4736 [ SWINSP] Swr Inspect 4/10/03 $35.00
[SWINSP] Swr Inspect 4/10/03 $0.00
Contractor:
Total $2,335.00
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" Perm
Is ed by: � _�4 i l ' 1 12 I Permittee Signature: 41111•'4,AjdaWAN
_
Call (503 639 -4175 by 7:00 P.M. for an inspection needed th. next bu ness .