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Permit CITY TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT #: SWR2002 -00073 =--'` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/22/02 SITE ADDRESS; 13255 SW YALE PL PARCEL: 2S104DA -QHS40 SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5 BLOCK: LOT: 040 - JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SFA NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection Owner: FEES BROWNSTONE QUAIL HOLLOW LLC 12670 SW 68TH PKWY STE 200 Type By Date Amount Receipt PORTLAND, OR 97223 PRMT CTR 5/22/02 $2,300.00 27200200000 INSP CTR 5/22/02 $35.00 27200200000 Phone: 503 - 598 -7565 Total $2,335.00 Contractor: Phone: Reg #: Required Inspections 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 Issued by: Permittee Signature: fl Call (503.)J 9 -4175 by 7:00 P.M. for an inspection needed the next business da