Permit i . ,
4111 CITY OF TIGARD
SEWER CONNECTION
1 ;�� DEVELOPMENT SERVICES PERMIT #PERMIT SWR97 -0362 •
DATE ISSUED: 09/24/97
PARCEL: 28104DD -02500
SITE ADDRESS...:12879 SW RIDGEFIELD LN
SUBDIVISION •MOUNTAIN HIGHLANDS *2 ZONING: R -4.5 PD
BLOCK LOT •022 JURISDICTION: 774—
TENANT NAME •GARY LONG
USA NO • FIXTURE UNITS...: 0
CLASS OF WORK. ..:NEW DWELLING UNITS..: 1
TYPE OF USE •SF NO. OF BUILDINGS: 1
INSTALL TYPE •BUSWR IMPERV SURFACE: 0 sf
Remarks: SFD — Path 1
Owner: FEES
GARY LONG type amount by date recpt
8290 SW LANDAU ST WQUL $ 210.00 GEO 09/24/97 97- 299514
TIGARD OR 97223 WQUA $ 290.00 GEO 09/24/97 97- 299514
PRMT $ 2200.00 GEO 09/24/97 97- 299514
Phone #: INSP $ 35.00 GEO 09/24/97 97- 299514
EROS $ 88.00 GEO 09/24/97 97- 299514
Contractor: ERPU $ 28.60 GEO 09/24/97 97- 299514
SUMMIT CONSTRUCTION ERPC $ 28.60 GEO 09/24/97 97- 299514
PO BOX 10345
PORTLAND OR 97210
Phone #: 223 -9703 $ 2880.20 TOTAL
Reg 41..: 000632
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
of the Unified Sewage Agency. The permit expires 188 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.
ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR
95214810 through OAR 95241 You lay obtain copies of
these rules or direct quest to MC b calling (583)246 -1987. , 41110
�/ i f •
Issued by gi .L�l.�i Pe rmittee Signature `��� L_ �� I
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Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
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