Permit CI OF TIRD
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CMOFTIIFARD SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT \ OREGON / PE RM I T
13125 SW Hall Blvd. P.O. Box 23397, Tigard, Oregon 97223 (503) 639.4175 \ / / PERM I T # S W R 9 3 —1210 2 7
639 -4171 DATE ISSUED: 01/15/93
SITE ADDRESS...: 12435 SW 121ST AVE PARCEL: 2S103BB -06900
SUBDIVISION . ZONING: R-4.5
BLOCK ° LOT °
TENANT NAME JOZSEF LORINC
USA NO FIXTURE UNITS... :16
CLASS OF WORK. :ADD DWELLING UNITS.. :1
TYPE OF USE— °°:OTR NO. OF BUILDINGS:1
INSTALL TYPE °BUSWR IMPERV SURFACE. °: :s
Remarks: Add 4 bedrooms to care home.
Owner: FEES
J & K LORTNC type amount ' by date recpt
12435 SW 121ST AVE PRMT $ 2100.00 JH 01/15/93 —
TIGARD OR 97223
Phone #:
Contract or:
CONTRACTOR NOT ON FILE
Phone #: $ 2100.00 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 V
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 will install a lateral.
Permittee Signature: V
Issued By:
- Call for inspection — 639 -4175
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