Permit CITY OF TIGARD SEWER CONNECTION
3—
PERMIT
COMMUNITY DEVELOPMENT DER4 T DATE ISSUED: PERMIT #.. ° ° ° ° • ° 4/05 5 /94
0471
13125 SW Hall Blvd. Tigard, Oregon 97223.81W 03)' 36 -4171 /94
PARCEL: 2S101BC —KNOL2
SITE ADDRESS— : 12419 SW KNOLL DR
SUBDIVISION • ZONING:
BLOCK • LOT
TENANT NAME— .
USA NO ° • : FIXTURE UNITS... :
CLASS OF WORK ° ° ° :MOV DWELLING UNITS.. :1
TYPE OF USE. . ° ° ° :SF NO. OF BUILDINGS :1
INSTALL TYPE.... :BUSWR IMPERV SURFACE— : :sf
Remarks:
Owner: FEES
FRED PASSMORE type amount by date recpt
12665 SW 27TH STREET PRMT $ 2200.00 JG 04/05/94 —
INSP $ 35.00 JG 04/05/94 —
BEAVERTON OR 97005
Phone #l:
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 22.:15.00 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 186 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 wi :- •st•11 a lateral.
Permittee Signature: / % - •
Issued B y: mi l) /
Call for inspection — 639 -4175
q3- �� 27L/Lf