Permit • SEWER CONNECTION
CITY OF TIGARD PERMIT
PERMIT # ° ° ° ° ° ° °: SWR96 -0166
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/14/96
13125 SW Hall Blvd. Tigard, Ore on 9 3.81 9 (503) 839 -4171
/ PARCEL: 1S136CA -02007
SITE ADDRESS... : tiZtert-S SW 78TH AVE
SUBDIVISION ZONING: R -4.5
•
BLOCK LOT
TENANT NAME— ° ° °
USA NO FIXTURE UNITS ° ° °: 0
CLASS OF WORK° ° ° : NEW DWELLING UNITS° ° : 1
TYPE OF USE °SF NO. OF BUILDINGS: 1
INSTALL TYPE.... :BUSWR IMPERV SURFACE: 0 sf
Remarks: PATH I
Owner: FEES - - - - -•
ELIJAH & EGHBAL ROSTAMIAN type amount by date recpt
3830 SW CALDEW ST PRMT $ 2200.00 B 05/14/96 96- 279347
INSP $ 35.00 B 05/14/96 96-279347
PORTLAND OR 97219
Phone #: 246 -3516
Contract or: --
CONTRACTOR NOT ON FILE
Phone #: $ 2235.00 TOTAL
Reg #° °
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect i a n
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 all purchase
a "Tap and Side Sewer" Permit and the Agenc • inst 11 a lateral.
Adi Permittee Signature: /
Issued By: A I ■ / r ..or/�
Call for inspection — 639 -4175