Permit ' 1
CITY TIGARD • SEWER CONNECTION PERMIT
PERMIT #: SWR2001 -00183
DEVELOPMENT SERVICES DATE ISSUED: 6/7/01 �
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 12630 SW WALNUT PARCEL: 2S104AD -03801
SUBDIVISION: ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connect to sewer. Septic tank must be removed or pumped and filled & inspected
Owner:
FEES
NANCY SMITH Type By Date Amount Receipt
12630 SW WALNUT STREET
TIGARD, OR 97223 PRMT CTR 6/7/01 $2,300.00 27200100000
INSP CTR 6/7/01 $35.00 27200100000
Phone: 503 - 524 -8895 Total $2,335.00
Contractor:
Phone:
Reg #:
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" 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.
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Issued by: Permittee Sig nature: I,4
�iy p �
Call (50 639 -4175 by 7:00 P.M. for an inspection needed the next ` business day
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