Permit 1
SEWER SEWER CONNECTION
PERMIT
CI1YOF TIGARD PERMIT #.......: BWR95
"COMMUNITY DEVELOPMENT ..E.~.....~ --.� VNl[ DATE ISSUED: 06/29/95
I
1o1oamw Hall Blvd. Tigard, Oregon 97223°819e (503) 639-4171
PARCEL: 2S104CA-02100
SITE ADDRESS...: 13687 SW LAUREN LN
• SUBDIVISION....: HILLSHIRE ZONING: R-7 PD
BLOCK..........: LOT ..... ..'.....:021
_____ _ _ . __ ____
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 -------- —
PARROTT MTN. CON type amount by date recpt
16260 SW BELL RD PRMT $ 2200.00 B 06/29/95 —
INSP $ 35.00 B 06/29/95 —
SHERWOOD OR 97140
Phone #: 625-6963
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 18N days froo ______ ____
the date issued. The total amount paid will be forfeited if the ______ __ __
peroit expires. The Agency does not guarantee the accuracy of the __
side sewer laterals. If the sewer is not located at the u»asor0000t ___ ____
given, the installer shall prospect 3 feet in all directions fron __ __
the distance given. If not so located, the installer shall purchase
a "Tap and Side it and the Agency will install ateral.
-
Permittee __
— ----' -- — -- -. 8 Issued By —
Call for inspection — 639-4175
.
•
.
_ _ ____
,//
���_~ � 17 ^� / `�
� °� .