11860 SW CARMEN STREET-1 co
rn
0
fn
n
D
m
z
rn
11860 SW CARMEN ST
CITYOF TIGA,RD SEWER CONNECTION PERMIT
DEVELONMENT SERVICES PERMIT #: SOIR2003-00336
13125 SW Hall Blvd., Tigard, OR 9722' (503) 639-4171 DATE ISSUED: 8/26/03
SITE ADDRESS; 11860 SW CARMEN ST
PARCEL: 2S103BD-02500
SUBDIVISION: CARMEN PAkh ZONING: K-4
BLOCK: LOT: unn JURISDICTION: I N,
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 lateral. Reimbursement District fee paid on this date.
Owner: — ----
_ _FEES
RHONE, HENRY JR Description i Date Amount
WAYNE, ROSALIE E _
11860 SW CARMEN �SWUSAJ 8/26/03 $2,400.00
TIGARD, OR 97223 ISWUSAI S\\rConnect 8/26/03 $0.00
Phone: (SWINSPI Swr Inspect 8/26/03 $35.00
Contractor: ISWINSPI Swr Inspect _ 8126/03 A $0.00
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 later3is. 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
sued by: ��>�Jr l- (� ��i /l t �'� Permittee Signature: /'o
Call (503)'639-4175 by 7:00 P.M. for an inspection needed the next business day