Permit _
y SEWER CONNECTION
^ PERMIT
CI PERMIT # ^ SWR95-0377
� � DATE IS SUED: 10/17/95
C0��QNUN�Y DEVEL0P��ENPAFITMENT
1o1csmw Hall Blvd. Tigard, Oregon o72o°o1nm (503) 639-4171 PARCEL: 25110BB-05600
SITE ADDRESS...: 14252 SW 121ST AVE
SUBDIVISION....: ARLINGTON RIDGE ZONING: R-3.5 �
BLOCK.. . . .. . . .. : LOT. . ... . ..... .. :033
_____ _
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
.
WILLIAM PARSONS type amount by date recpt
4050 SW BANCROFT PRMT $ 2200.00 JDA 10/17/95 95-271720
INSP $ 35.00 JDA 10/17/95 95-271720
PORTLAND OR 97221
Phone #: 222-1241
Contractor:
CONTRACTOR NOT ON FILE
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 will install a lateral.
_ __ ___
Permittee Signature: . __.
Issued By: ' _ _
[� Call for inspection — 639-4175
.
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