Permit CITY T SEWER CONNECTION
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DEVELOPMENT � L SERVICES PERMIT #.. F'ERMTT° SWR97 -0430
DATE ISSUED: 01/05/98
PARCEL: 2S1O4DB -03200
SITE ADDRESS °.. :13000 SW ROCKINGHAM DR
SUBDIVISION °AMESBURY HEIGHTS ZONING: R -4.5
BLOCK LOT °032 JURISDICTION° TIG
TENANT NAME °DALTON CONSTRUCTION INC
USA NO FIXTURE UNITS...: 0
CLASS OF WORK. .° :NEW DWELLING UNITS..: 1
TYPE OF USE °SF NO. OF BUILDINGS: 0
INSTALL TYPE °BUSWR IMP'ERV SURFACE: 0 sf
Remarks: SF — Path 1
Owner: -- FEES
DALTON CONSTRUCTION INC type amount by date recpt
8465 —A SW HEMLOCK ST PRMT $ 2200.00 GEO 01/05/98 98- 302272
TIGARD OR 97223 INSP $ 35.00 GEO 01/05/98 98- 302272
Phone #:
Contractor: -• - --
OWNER
Phone #: $ 2235.00 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.
ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 through OAR 952 -001- You may obtain copies of
these rules or direct questions to U '1. i. calling (503)246 -1987.
Issued by I " « Permittee Signature _� , '� , ,d0L 4 i t
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Call 639 -4175 by 7 :00 p.m° for an inspection needed the next business day
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