Permit C[W[R CONNECTION
PERMIT
� �� � �� OF � PERMIT # ... ^ S WR95-0394
�_~�� � � ��'� ~ ~ DATE ISSUED: 09/2
.COMMUNITY DEVELOPMENT DEPARTMENT
1o1usovv Hall Blvd. Tigard, Oregon 9722308199 (503) 639-4171 PARCEL: 2S104DC-06800
SITE ADDRESS...: 13870 SW FERNRIDGE TERR
SUBDIVISION....: MORNINGSTAR ZONING: R-4.5 PD
BLOCK.. .. .. .... : LOT.. . .... ^009
TENANT NAME.....:
USA N[].......... : 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
FEES --------------
Owner: ---
TOM ARVIDSON type amount by date recpt
15256 SW TEAL BLVD PRMT $ 2200.00 JSD 09/27/95 95-271030
# B INSP $ 35.00 JSD 09/27/95 95-271030
BEAVERTON OR 97007
Phone #: 590-2955
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 18N 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 Si
Alr
Issued By
Call for inspection — 639-4175
9)-11.66 ^�.
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