Permit CITY OFTIGARD
' i e , ,a : 4 A 00 ry�V 1 DEVELOPMENT SERVICES SEWER CONNECTION
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PERMIT # • SW R97 -0150
DATE ISSUED: 06/10/97
PARCEL: 2S104DB —AH023
SITE ADDRESS...:13151 SW ROCKINGHAM p2JVC
SUBDIVISION •AMESBURY HEIGHTS ZONING: R -4.5
BLOCK LOT •23 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 IMPERV SURFACE: 0 sf
Remarks: Path 1
Owner: FEES
DALTON CONSTRUCTION INC type amount by date recpt
8465 SW HEMLOCK ST PRMT $ 2200.00 B 06/10/97 97- 295692
TIGARD OR 97223 INSP $ 35.00 B 06/10/97 97- 295692
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.
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Permittee Signature: dNvIt 1h P' li
6 'AIJAJAkta4 1 --- - 11 P fkw � + � t' Issued By:
Call for inspection — 639 -4175
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