Permit CITYOF TIQARD
CIfYOFWARD SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT \ � + / PERM I T
13125 SW Hell Blvd. P.O. Boot 23397.1Igeid, Oregon 97223 (603) 839 -4175
PERMIT # • SWR92 -0403
639 -4171 DATE ISSUED: 01/29/93
SITE ADDRESS : 14104 SW LIDEN DR PARCEL: 2S104BB- 03700
SUBDIVISION : CASTLE HILL ZONING:
BLOCK LOT :030
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
YOUNIQUE HOMES type amount by date recpt
P 0 BOX 2016FORD PRMT $ 2100.00 JH 01/29/93 —
INSP $ 35.00 JH 01/29/93 —
LAKE GROVE OR 97035
Phone #: 624 -5766
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 2135.00 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 m.. regent
given, the installer shall prospect 3 f-:. - all dire ion from
the distance given. If not so locate', the ins aller ha purchase
a °Tap and Side Sewer" Permit and e Agency ill - nst. 1 a lat= -1.
Permittee Signature:
Issued By: , .
Call for inspection — 639 -4175
•
GI 3- .2-36 /39