Permit |
SEWER CONNECTION
c Irv 9 � ��� TIGARD
�^-���- ��� � PERMIT #....... : SWR94-0141
COMMUNITY DEVELOPMENT DERARTMENl[ DATE ISSUED: 05/16/94
13125 SW Hall Blvd. Tigard, Oregon 97223°8199 (503) 639-4171
PARCEL: 1S134AC—JE012
SITE ADDRESS...: 11057 SW 111TH PL
SUBDIVISION....: JEFFREY ESTATES ZONING: R-4.5 PD
BLOCK..........: LOT.............:012
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TENANT NAME.....:
USA NO..........: FIXTURE UNITS...:
CLASS OF WORK...:NEW DWELLING UNITS..:1
TYPE OF USE.....:SF NO. OF BUILDINGS:1
INSTALL TYPE....:BUSWR IMPERV SURFACE..: :sf
Remarks: PATH I
Owner: -------------------------------------------------- FEES --------------
FOUR D CONSTRUCTION type amount by date recpt
P 0 BOX 1571 PRMT $ 2200.00 SW 05/16/94 .
INSP $ 35.00 SW 05/16/94 .
BEAVERTON OR 97075
Phone #: 641-0935
Contractor: -----------------------------
CONTRACTOR NOT ON FILE
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Phone #: $ 2235.00 TOTAL
Reg #..:
• ------- REQUIRED INSPECTIONS -------
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
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" Permit and the Agency wi inst.11 a lateral.
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Permitter.? Sign '•ure
• 'P '------'----'--''---- -'---,---'----'---'-'
Issued By:
Call for inspection — 639-4175
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