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Permit CITY TIGARD SEWER CONNECTION PERMIT I DEVELOPMENT SERVICES PERMIT #: SWR2003 -00222 � I DATE ISSUED: 7/18/03 '` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 WHISTLER'S LN PARCEL: 2S103CC -11100 SITE ADDRESS; 12285 SW W HI S SUBDIVISION: WHISTLER'S WALK ZONING: R - 4.5 BLOCK: LOT: 058 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. Owner: FEES DON MORISSETTE HOMES 4230 GALEWOOD STE #100 Description Date Amount LAKE OSWEGO, OR 97035 [SWUSA] Swr Connect 7/18/03 $2,400.00 [SWUSA] Swr Connect 7/18/03 $0.00 Phone: 503 387 - 7538 [SWINSP] Swr Inspect 7/18/03 $35.00 [ SWINSP] Swr Inspect 7/18/03 $0.00 Contractor: Total $2,435.00 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 Issue by: ,0 �. / ' �- ±� Permittee Signature . At . .� , Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day