Permit iliA CITY OF TIGARD SEWER CONNECTION PERMIT
ll ° COMMUNITY DEVELOPMENT PERMIT #: SWR2006 - 00044
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/10/2007
PARCEL: 1S133CA-02600
SITE ADDRESS: 13831 SW ANNA CT ZONING: R -25
SUBDIVISION: GABRIEL WOODS LOT: 005 JURISDICTION: TIG
Project Description: New SFA sewer connection.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SFA NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
JOE BAUSCHELT FEES
4325 SW PRIMROSE ST Description Date Amount
PORTLAND, OR 97219
[SWUSA] Sewer Connection Fee 1/10/2007 $2,600.00
[SWINSP] Sewer Inspection Fee 1/10/2007 $35.00
Phone: 503- 860 -6001 Total $2,635.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
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" 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued by: 6.‘4,14—ed.4...0- Permittee Signature: A L
Call 503.639.4175 by 7:00 a.m. for an inspection that busi es day.
This permit card shall be kept in a conspicuous place on the job site until c • pletion of the project.
Approved plans are required on the job site at the time of ea inspection.