Permit `.�
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PERMIT CITY OF TIGARD
PERMIT 4$.......e SWR95 -0189
DATE ISSUE: 08/02/95
- COMMUNITY DEVELOPMENT. DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: C S1lZl4CA -o27OG
SITE ADDRESS... e 13543 SW LAUREN LN
SUBDIVISION....: HILLSHIRE ZONING: R -7 PD
BLOCK........... LOT..............e027
TENANT NAME.....:
USA NO........... FIXTURE UNI TS... A
CLASS OF WORT:... :NEW DWELLING UNI T S.. e 1
TYPE OF USE......... e SF NO. OF BU I LD I NGS e i
INSTALL TYPE.... CBUSWR IMPERV SURFACE..: a ar°
Remarks: PATH I
Owner: -- _.___- FEES
MAHST N TORABI type amount by date recpt
270 SW FERNWSOON WAY PRMT $ 2200.00 JD O8 /02 /9 5 95-- 268786
INSP $ 35.017.1 JD 08/02/95 95- 268786
BEAVERTON OR 97005
Phone 44=4 626 -7287
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Contractors
CONTRACTOR NOT ON FILE
Phone #: $ 2235.00 TOTAL
Reg 4$... .
------- - REQUIRED INSPECTIONS -----
This Applicant agrees to cooply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The percit expires 180 days from
the date issued. The total amount paid will be forfeited if the
percit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is net located at the ceasurecent
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shat pur_ ase
a 'Tap and Side Sewer' percit and the Agency pail instal' a lateral.
Permittee Signature: /
Issued Bye _ . 4: 71.777.--)
Call for inspection - 639-4175
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