Permit . A CITY OF T D SEWER CONNECTION
PERMIT
e /AM DEVELOPMENT SERVICES PERMIT * • 5WR96 -0512
1 � .. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 01/07/97
PARCEL: 2S104BA -15600
SITE ADDRESS...: 13578 SW LIDEN DR
SUBDIVISION • CASTLE HILL NO.3 ZONING: R -12 PD
BLOCK • LOT •186
TENANT NAME -DON MORISSETTE HOMES
USA NO • FIXTURE UNITS...: 0
CLASS OF WO RN....: NEW - DWELLING UNITS..: 1
TYPE OF USE •SF NO. OF BUILDINGS: 1
INSTALL TYPE •BUSWR IMPERV SURFACE: 0 sf
Remarks: Path 1
Owner: FEES
DON MORISSETTE HOMES type amount by date recpt
5000 SW MEADOWS RD #151 PRMT $ 2200.00 B 01/07/97 97- 288548
INSP $ 35.00 B 01/07/97 97- 288548
LAKE OSWEGO OR 97035
Phone #: 620 -7538
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 1B@ 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 the Agency will install a lateral.
Permittee Si nat�_ire:QQ ka—liilil_____
Issued B . b �� l..
Y
Call for inspection — 639 -4175