Permit r \ '
�
, CITY OF TIGARD
SEWER CONNECTION PERMIT
I DEVELOPMENT SERVICES PERMIT #: SWR2001 -00324
. ,� II 13125 SW Hall Blvd., Tigar OR 97223 (503) 639 -4171 DATE ISSUED: 12/12/01
SITE ADDRESS; 12065 SW WALNUT ST PARCEL: 2S1036A -01003
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: 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: Connect existing residence to newly installed sewer lateral. Septic tank must be pumped, filled and
inspected. Reimbursement District #18 fee has been paid.
Owner:
FEES
WASHINGTON COUNTY
1400 SW WALNUT ST MS #18 Type By Date Amount Receipt
HILLSBORO, OR 97123 INSP CTR 12/12/01 $35.00 27200100000
PRMT CTR 12/12/01 $2,300.00 27200100000
Phone: 503 - 846 -7840 Total $2,335.00
Contractor:
KERR CONTRACTORS INC
19350 SW 89TH AVE
TUALATIN, OR 97062
Phone: 692 -5514
Reg #: LIC 72599
Required Inspections
Sewer Inspection
•
Septic Tank Filled
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
IP
Iss ed by: �' ��_�I}� ! ' Permittee Signature: )C
Call (503) 639 , 175 by 7:00 P.M. for an inspection needed the next business day