Permit SEWER CONNECTION
PERMIT
CITY OFTIGARD PERMIT #.......: SWR94-0072
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• COMMUNITY DEVELOPMENT DEVELOPMENT ����°~��..".�.~T DATE ISSUED: 04/06/94
1o1oamw Hall Blvd. Tigard, Oregon 97223°8199 (503) 639-4171
PARCEL: 2S104CA-02600
SITE ADDRESS...: 13571 SW LAUREN LN
SUBDIVISION....: HILLSHIRE ZONING: R-7 PD
BLOCK..........: LOT ^026
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..: :s
Remarks: PATH I
Owner: — FEES —
J ROTH type amount by date recpt
12780 SW 68TH AVE PRMT $ 2200.00 JG 04/06/94 —
INSP $ 35.00 JG 04/06/94 —
TIGARD OR 97224
Phone #: 639-2639
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 shall purchase •
a "Tap and Side Sewer" Permit and the ^goocy will install a lateral.
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Permittee Signature:
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Issued By: .
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Call for inspection — 639-4175
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