Permit •
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PERMIT '
PE�MIT #..... ..: SWR95-@277
CI1Y OFTI GARD DATE ISSUED: 07/17/95
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^ COMMUNITY DEVELOPMENT 1
13125 SW Hall Blvd. Tigard, Oregon e7223°81e* (503) 639-4171 PARCEL: 2S104BD-RMO23
SITE ADDRESS...: 12701 SW 138TH AVE
SUBDIVISION....: ROSE MEADOWS ZONING: R-7 �
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8LOCK.. .... .... : LOT. ............ :023
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TENANT NAME. .... :
USA N8..........: FIXTURE UNITS...:
CLASS OF WORK...:NEW DWELLING UNITS..:1
TYPE OF USE.....:SF NO. OF BUILDINGB:1
INSTALL TYPE.... :BUSWR IMPERV SURFACE..: ' :sf
Remarks: PATH I
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Owner: - - FEES ----- --
JAY MILLER ` type amount by date recpt
P 0 BOX 230459 • PRMT $ 2200.00 B 07/17/95 95-268097
INSP $ 35.00 B 07/17/95 95-268097
TIGARD OR 97281
Phone #: 684-7543
Contractor: - ------
CONTRACTOR NOT ON FILE
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Phone is $ 2235.00 TOTAL
Reg #..: -
-- REQUIRED INSPECTIONS
This Applicant agrees to cooply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The pmnit expires 0Ndays from . ____
the date issued. The total auoout paid will helurfeited 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 frog
the distance given. If not so located, the installer shall purchase
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a "Tap and Sewer" Remit an�th� ^gencywill lateral.
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Permittee Si ature: ���N� _ _ � _____ ______
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Issued By: +~�. L_--- ____ __�
Call for inspection — 639-4175
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