Permit SEWER CONNECTION
Is CITY OF Ti PERMIT c_
39 p DATE 10/16/95 �Zi4`
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 291 04BA— i 0100
SITE ADDRESS...: 13740 SW LIDEN DR
SUBDIVISION • CASTLE HILL ZONING: R -12
BLOCK • LOT •
TENANT NAME •DON MORRISETTE
USA NO • FIXTURE UNITS...:16
CLASS OF WORK...: NEW DWELLING UNITS..: 1
TYPE OF USE •SF NO. OF BUILDINGS:1
INSTALL TYPE •BUSWR IMPERV SURFACE..: :sf
Remarks: Construct single family dwelling
Owner: FEES
DON MORRIESETTE HOMES, INC. type amount by date recpt
5000 SW MEADOWS, INC. PRMT $ 2200.00 JDA 10/16/95 95- 271695
INSP $ 35.00 JDA 10/16/95 95- 271695
LAKE OSWEGO OR 97035
Phone #: 503 -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 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 the Agency will install a lateral.
Permittee Signature:
lAtii_ ___
Issued By :•_,/ L�..A / . ._
Call for inspection — 639 -4175
95 — ` 7f& 3
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