Permit CITY TIGARD SEWER CONNECTION PERMIT
A.gove PERMIT #: SWR2003 -00205
�L4 DEVE H BMEMIg Tigard, R 2CE 639 -4171 DATE ISSUED: 6/27/03
SITE ADDRESS; 12820 SW WALNUT ST PARCEL: 2S104AD -03501
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 house to sewer.
Owner:
FEES
CHRISTOPHER JAM
12820 SW WALNUT ST Description Date Amount
TIGARD, OR 97223 [ SWINSP] Swr Inspect 6/27/03 $35.00
[SWINSP] Swr Inspect 6/27/03 $0.00
Phone: [SWUSA] Swr Connect 6/27/03 $0.00
[SWUSA] Swr Connect 6/27/03 $2,300.00
Contractor:
Total $2,335.00
Phone:
Reg #:
•
Required Inspections
Sewer Inspection
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
Issu by: 1 F c -� e ekvi Permittee Signature: ,-- gi,V)
Call (503) 6 9 -4175 by 7:00 P.M. for an inspection needed the next busines day