Permit _ _
SEWER CONNECTION
C � ��� OF � PERMIT
� � � � ~ � PERMIT #....... : SWR94-0074
COMMUNITY DEVELOPMENT DEIARMENT DATE ISSUED: 03/28/94
1o1dsoW Hall Blvd. Tigard, Oregon 97223081ee (503) 639-4171
PARCEL: 25104CA-02500
SITE ADDRESS...: 13599 SW LAUREN LN
SUBDIVISION....: HILLSHIRE ZONING: R-7 PD
BLOCK ^ LOT ~025
___
TENANT NAME.....:
USA NO..........: FIXTURE UNITS...:
CLASS OF WORK...:NEW DWELLING UNITS..:1
TYPE OF USE. ....:SF NO. OF BUILDINGS:1
I INSTALL TYPE....:BUSWR IMPERV SURFACE..: :sf
Remarks: PATH I •
Owner: — — FEES
J ROTH type amount by date recpt
12480 SW 68TH PRMT $ 2200.00 SW 03/28/94 —
INSP $ 35.00 SW 03/28/94 —
TIGARD OR 97224
Phone #: 639-2639
Contract or:
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 t e vii 1 ins :11 a lateral.
Permittee Signatur
Issued By:
(P
Call for inspection — 639-4175
_����
rY ���� �