Permit � CITYOF �� ' ��n���—����� '�==
CITYOF TIGARD SEWER CONNECTION |
COMMUNITY -� PERMIT
m1osmw Hall Blvd. P.O. Box m33um. Tigard, Oregon 97223 (503) 639-4175
PERMIT #.......: SWR92-0349
639-4171 DATE ISSUED: 01/27/93
SITE ADDRESS...: 12250 SW LANBDOWNE LN PARCEL: 28103BC-07100
SUBDIVISION....: FYRESTONE . ZONING: R-4.5
BLOCK ^ LOT. ............:10
• •
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..: :sf
Remarks: PATH I .
Owner: FEES
MAJESTIC HOMES type amount by date recpt
25 SE 82ND DRIVE PRMT $ 2100.00 .H 01/27/93 0
INSP $ 35.00 .H 01/27/93 0
GLADSTONE OR
Phone *: 655-6263 •
. Contractor:
CONTRACTOR NOT ON FILE
.
Phone #: $ 2135.00 TOTAL
Reg #..: '
REQUIRED INSPECTIONS --- --
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
of the Unified Sewage Agency. The permit expires 180 days from
�
days
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 latehal*. If the sewer is not located at the oas t
given, the installer shall prospect ` f »t n . d
the distance given. If not "
so locate', th i 'ta l' 4��
�
a 'Tap and Side Sewer' Permit and th: Agp'cy wi i �
Permittee Signature: ~__~ ^
��
Issued By: �� •
�
Call for inspection — 639-4175 •
.
.
. .
.
����_ _ .` _ •
.
•
' y7 ��
�~~� .=. � ~�» . .
. . .
•