Permit twL' K LUNNL I 1 UN
• CI TY OF TIGARD PFRMIT # 4 PERMIT c
SWR95 -02.34
DATE ISSUED: 06/`7/95
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 2S 104BD —RM009
SITE ADDRESS...: 13763 SW ROSY CT
SUBDIVISION • ROSE MEADOWS ZONING: R -7
BLOCK........... LOT •009
TENANT NAME •
USA NO • FIXTURE UNITS...:
CLASS OF WORK...:NEW DWELLING UNITS..:1
TYPE OF USE •SF NO. OF BUILDINGS:1
INSTALL TYPE •BUSWR IMPERV SURFACE..: :sf
Remarks: PATH I
Owner: - - - -- - - - -- - FEES -- - - -- - - - --
JAY MILLER type amount by date recpt
P 0 BOX 23291 PRMT $ 2200.00 B 06/27/95 —
INSF' $ 35.00 B 06/27/95 —
TIGARD OR
Phone 4: 684 -7543
Contract or:
CONTRACTOR NOT ON FILE
Phone 4*: $ 2235.00 TOTAL
Reg 4...
— REQUIRED INSPECTIONS --- - - - - --
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires l80 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 S. ature: _____ — S _
Issued By: _ ,_.___
Call for inspection — 639 -4175
•
5/24/00. Activities for Case #: SWR95 -00234
2:09:19 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA007 Application received BLT 6/13/95
SWRA010 Plan check by 6/13/95 BLT 6/13/95
SWRA020 Check for prcl. restrict. 6/13/95 6/12/95 SW PASS • BLT 6/13/95
SWRA705 Sewer Inspection BLT 6/13/95
•
SWRA080 (F) Issue permit 6/27/95 BON B 6/27/95
SWRA720 Case Finaled 7/13/95 MS PASS MRS 7/13/95 •
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