Permit _--
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CITY � SEWER CONNECTION
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DEVELOPMENT SERVICES �~~~� m~~~�~. .°.=~.� " ~�m~n u�"�~~~~� PERMIT
......._W �� 13125 SW Hall Blv� Tigard, OR87223 (03)639-4171 PERMIT #. . . . . . . : SWR96-0478
DATE ISSUED: 04/16/97
PARCEL:'2S1694CA-03100
SITE LAUREN LN •
SUBDIVISION ^HILLSHIRE ` .ZONING: R-7 PD
BLOCK.......... LOT ^031 JURISDICTION: TIG
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TENANT NAME ^HILLSHIRE ESTATES
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 1
Owner: - , FEES. ' ` ' ,
ALAN NAYLOR type amount by date recpt
6955 SW JUNIPER TERR PRMT $ 2200.00 JSD 04/16/97 97-293337
BEAVERTON OR 97008 INSP $ 35.00 JSD 04/16/97 97-293337
Phone #:
Contractor: . -
OWNER .
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Phone #: $ 2235.00 TOTAL - - '-
Reg4E,.:'
REQUIRED INSPECTI
This Applicant agrees- to comply with all the ruUes•aod regulations Sewer Inspect _ ______
of the Unified Sewage Agency. The permit expires 180 days from • ____ .
the date issuedx The' total' amount paid. will be forfeited if . _
permit pxpires;''The Agency does not guarantee the accuracy of the —
side sewer laterals. If the sowpr is not located. at the measurement' . � _
given, the iostaDer''shall'pruspect 3 feet' in all'directinns from '' • • _ _
the distance given. If Mot louated,'the installer hall pordas. ' �__�___ ____ ________ •
a "Tap Ind Side Sewer" Permit and•thp Agency will ' ; tall 'a'/ato . _ __________
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Permittee Signature: _ ,,' . _�___
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Issued By: f ' �
• Call for inspection _ 63974175
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