Permit CITY T SEWER CONNECTION PERMIT
�l� DEVELOPMENT SERVICES PERMIT #: SWR2002 -00134
A 13125 SW Ha Blvd.; Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/15/02
SITE ADDRESS; 11234 SW 84TH AVE PARCEL: 1S136CB-10200
SUBDIVISION: ASH CREEK MEADOWS ZONING:. R-7
BLOCK: LOT: 006 JURISDICTION: TIG
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: Sewer connection permit for new SF detached residence.
Owner: FEES
ESLINGER BUILDERS INC Type By Date Amount Receipt
11575 SW PACIFIC HWY. -
PMB160 PRMT CTR 4/15/02 $2,300.00 27200200000
TIGARD, OR 97223 -_ • INSP CTR. 4/15/02 $35.00 27200200000
Phone: 503 - 620 -9515 . 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
tvb Issued by r f / �� Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business ay