Permit CITY OF TIGARD SEWER CONNECTION
DEVELOPMENT PERMIT
I.* IL. 13125 OR SERIES PERMIT # SWR97 -0119
Tigard, (503)639-4171 DATE ISSUED: 04 /24/97
PARCEL: 25104DD -01700
SITE ADDRESS...: 12945 SW RIDGEFIELD LN
SUBDIVISION •MOUNTAIN HIGHLANDS #2 ZONING: R -4.5
BLOCK LOT -014 JURISDICTION: TIG
TENANT NAME •Y00 HI CHIN
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: Path 1
Owner: FEES
YO0 HI CHIN type amount by date recpt
1717 SW PARK AVE PRMT $ 2200.00 JMH 04/24/97 97- 293704
PORTLAND OR 97201 INSP $ 35.00 JMH 04/24/97 97- 293704
Phone #:
Contractor:
OWNER
Phone #: $ 2235.00 TOTAL
Reg L. .
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:
c
Issued By: / .. � 44 _(.'
Or Call for inspection —'639 -4175
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