Permit SEWER CONNECTION
• PERMIT
CITY OF TIGARD
F �ERMIT # SWR5 -0360
9
DATE ISSUED: 10/09/95
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: 26104BA -07700
SITE ADDRESS...: 13920 SW LIDEN DR
SUBDIVISION • CASTLE HILL #2 ZONING: R -12 PD •
BLOCK • LOT •112
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
DON MORISSETTE type amount by date recpt
5000 SW MEADOWS RD PRMT $ 2200.00 B 10/09/95 95- 271416
SUITE 151 INSP $ 35.00 B 10/09/95 95- 271416
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 180 days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the - • . -
side sewer laterals. If the sewer is not lo at ' uremen
given, the installer shall prospect 3 f•• in al •irection. fro
the distance given. If not so located the ins :11er shall pu ' ase
a °Tap and Side Sewer° Permit and _Agency 11 insta . • ateral.
vlsoog
Permittee Si.nature:
Issued By: Oa ' I . L _i
Call for inspection — 639 -4175
•