Permit •
4 111h , CITY OF TIGARD SEWER CONNECTION PERMIT
Avi Ni
el DEVELOPMENT SERVICES PERMIT #: SWR2002 -00102
DATE ISSUED: 4/18/02
+� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 14225 SW 128TH PL PARCEL: 2S109AA -04800
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7
BLOCK: LOT: 014 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: s/f Path 1
Owner: FEES
MASTERPIECE CONSTRUCTION INC Type By Date Amount Receipt
15435 SW ASHLEY DRIVE
TIGARD, OR 97223 PRMT CTR 4/18/02 $2,300.00 27200200000
INSP CTR 4/18/02 $35.00 27200200000
Phone: 503 - 267 -6730 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: _ alfr Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day