Permit CITY OF T SEWER CONNECTION
PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT # ° SWR94 -0189
13125 SW Hall Blvd. Tigard, Oregon 972230B19iP 974171 DATE I SSUED a 06 /28/94
PARCEL: 2S111CB -03000
SITE ADDRESS— .° 10067 SW LADY MARION DR
SUBDIVISION.... a MARION ESTATES ZONING: R-3.5
BLOCK........... LOT -003
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
TIM MILLER type amount by date recpt
13027 SW TIMA RA LN PRMT $ 2200.00 SW 06/28/94 —
INSP $ 35.00 SW 06/28/94 —
TIGARD OR 97224
Phone #: 598 -8574
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 sh- 1 .'rchase
a "Tap and Side Sewer" Permit and the Agency -. 1 - lateral.
/ �- ' Permittee Sign ati_red
n
Issued By: VAS
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Call for inspection — 639 -4175