Permit uummMLilUN
PERMIT
OF � PERMIT #. . ... .. : SWR95-0487 Cliv DATE ISSUED: 12/07/95
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd Tigard, Oregon 9722 3.8199 (5n3)n39-4171 PARCEL: 1S125CD-07100
SITE ADDRESS...: 09718 SW LANDAU PL
SUBDIVISION....: LANDAU WOODS ZONING: R-4.5
BLOCK..........: LOT.............:008
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TENANT NAME ~
USA NO..........: FIXTURE UNITS...: 0
CLASS OF WORK...:NEW DWELLING UNITS..: 1
TYPE OF USE. ....:SF NO. OF BUILDINGS: 1
INSTALL TYPE. ...:BUSWR IMPERV SURFACE: 0 sf
Remarks: PATH I
Owner: -- FEES
MICHAEL CHURCH type amount by date rerpt
7440 SW 35TH PRMT $ 2200.00 JDA 12/07/95 95-273661
INSP $ 35.00 JDA 12/07/95 95-273661
PORTLAND OR 97219
Phone #: 503-293-2109
Contractor: ---
MICHAEL CHURCH HOMES INC
7440 SW 35TH
PORTLAND OR 97219
Phone #: 293-2109 $ 2235.00 TOTAL
Reg #..: 91961
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect i on
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
piveo, the installer shall prospect 3 feet in all directions from __
the distance given. If not so located, the installer = l purchase
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a "Tap and Side Sewer" the Agency ill . _
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Permittee Signature: __ _____ _____�___ ____
Issued By:
Call for inspection — 639-4175
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