Permit CITY OF T CONNECTION
PERMIT
MIT # °... °. °: SWR95-1Z1267
COMMUNITY DEVELOPMENT DEPARTMENT D(TE ISSUED: 07/12/S5
13125 SW Hell Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 2S 1 09 BA —HS249
SITE ADDRESS...: 14:68 SW RACELY I=LL •
SUBDIVISION ZONING:
BLOCK LOT
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 - -- -- - - - - -- - --
LHL CONSTRUCTION INC type amount by date recpt
7110 SW FIR LOOP PRMT $ 220+Z0.00 JDA 07/12/95 —
SUITE 160 INSP $ 35.00 JDA 07/12/95 --
TIGARD OF 97223
Phone it: 624 -7714
Contractor: •
CONTRACTOR NOT ON FILE
Phone #: $ 2235. 00 TOTAL
Reg #° . :
REQU I RED 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 in faller all purchase
a "Tap and Side Sewer" Permit and the Agen, i l :.ta11 a lateral.
Permittee Signature: .4 1LI _
Issued By: - / _ _ — —
Call for inspection — 639-4175