Property Information

You must enter either a Tax Map & Lot ID (i.e. 1S234AB01400) or Site Address, but you do not have to enter both.

Tax lot ID(s):

Site Address:

City:

State:

Zip:

Nearest Cross Street:

In which jurisdiction would you get permits for this project?

Washington County Clackamas County Multnomah County Banks Beaverton Durham Cornelius Forest Grove Gaston Hillsboro King City Lake Oswego North Plains Portland Rivergrove Sherwood Tigard Tualatin

Owner Information

Name:

Company:

Address:

City:

State:

Zip:

Phone/Fax:

E-Mail:

Applicant Information

Name:

Company:

Title:

Address:

City:

State:

Zip:

Phone/Fax:

E-Mail:

Development Activity

Check all that apply

Other:

Off-site Work

Will the project involve any off-site work?

No Yes I'm not sure

Site Plan

Would you like to submit a site plan?

No, thank you. Yes, please!

Additional Comments

Additional comments or information that may be needed to understand your project

Submit

By submitting this form the Owner, or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site.

Additionally, I certify that I am familiar with the information contained in this document, and to the best of my knowledge and belief, this information is true, complete, and accurate.

Entries missing a fax number will be mailed to the Applicant's postal address. Submittals returned by postal mail will take additional time beyond our five working day timeframe to reach the applicant.