Permit CITYOF TIRD CM MOFWARD SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT OREGON PERMIT
1om25mw Hell Blvd. po Box o3397.rigetd. Oregon mra23;50gam9-41rs PERMIT # ' SWR92-0385
639-4171 DATE ISSUED: 02/01/93
SITE ADDRESS...: 11957 SW 129TH PL PARCEL: 1S133DD-16300
SUBDIVISION....: VILLAGE AT SUMMER LAKE PARK 5 ZONING: R-4.5
BLOCK ^ LOT :199
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 •
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Owner. FEES
MORISGETTE HOMES type amount by date recpt
15555 SW BANGY RD PRMT $ 2100.00 JH 01/29/93 — .
INSP $ 35.00 JH 01/29/93 —
LAKE OSWEGO OR 97035
Phone #: 620-7538 '
Contract or:
CONTRACTOR NOT ON FILE
Phone #: $ 2135.00 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 loc. 'd, the 'nstallor shall purchase
a "Tap and Side Sower" Permit - d the Agency will install a lateral.
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Permittee Signature: i ~ ^ --- ____� __
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Issued By:
• ' Call for inspection — 639-4175
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