Permit CITY OFTIGARD
� DEVELOPMENT SERVICES SEWER CONNECTION
i jl'I PERMIT
" 1. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # • SW R97 -0151
DATE ISSUED: 06/04/97
PARCEL: 2S104DB —AH045
SITE ADDRESS...:13142 SW ROCKINGHAM DR
SUBDIVISION -AMESBURY HEIGHTS ZONING: R -4.5
BLOCK LOT •45 JURISDICTION: TIG
TENANT NAME •
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
GREG SIMMONS type amount by date recpt
4214 SW KANAN DR PRMT $ 2200.00 DRA 06/04/97 97- 295432
PORTLAND OR 97221 INSP $ 35.00 DRA 06/04/97 97- 295432
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.
Permittee Signature: ,,A,ip.
Issued ByC0.0-(Y6Z,Nrv■A-ki
Call for inspection — 639 -4175
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