Permit •
CITY OF TIRD (-- ..1 - ,P•iik
COMMUNITY DEVELOPMENT DEPARTMENT SOON SEWERPERMITCTION
13125 SW Hall Blvd P.O. Bout 23397, lipid, Oregon 97223 (603) 639 -4175 .......OR / P E R M I T # • SW R 9 3 — 010 0
639 -4171 DATE ISSUED: 03/03/93
SITE ADDRESS...: 14051 SW LIDEN DR PARCEL: 2S104BB -04200
SUBDIVISION • CASTLE HILL ZONING:
BLOCK LOT. . . . . ........ : 025
TENANT NAME
USA NO FIXTURE UNITS...:
CLASS OF WORK... :NEW DWELLING UNITS. .:1
TYPE OF USE •SF NO. OF BUILDINGS :I
INSTALL TYPE •BUSWR IMPERV SURFACE..: :sf
Remarks: PATH I
Owner: FEES .
MLADEN BAR ICEVIC type amount by date recpt
10980 SW EASTRIDGE # 106 PANT $ 2100.00 JH 03/03/93 —
INSP $ 35.00 JH 03/03/93 —
PORTLAND OR 97225
Phone #: 292 -5915
Contract or:
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 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: G�/C���"" _ —
A
Issued By: _
Call for inspection — 639 -4175
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