S 10-86 POOR QUALITY RECORD
PLEASE NOTE: The original paper record has been archived and
put on microfilm. The following document is a copy of the
microfilm record converted back to digital. If you have questions
please contact City of Tigard Records Department.
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CITY OF TIGARD, 12755 SW Aah, V) ox 23397 ,e.„,,,,1 ,,•fr.. .
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a rd Oregon 97223— (503) (139-4171 " FOR STAFF USE ONLY
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RECEIPT NO.
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. APPLICATIO0 k CEPTED BY.
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1 CENERIL INFORMATION • AppljAcation elements submitted:
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PROPERTY AVDRESE/LOCATION S.W. 1,30tithygnuct_ ' of (A) Application form (1)
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TAX MAP AND TAX LOT N0,I/JNI__Liigs authorization
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/1/(C) Title transfer instrument (1)
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PROPERTY OWNER/DEED NOLDPR* Centur• 21 Prooerties Ioc. , __Ae,(E ,reliminary Plat . copies;
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ADDRESS 7160 SW Hazel Fern Rd. PHONE 684.R762 . • fvF) Applicant's statement
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ctTY Tua1atin EIP 97062 (15 coies)
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44..W4.. APPLICANT*
„:;";:4.M'',i',':•)::,.t,',.',; \ (0) List lif property owner s
g,:i..;it,,i..,,',;-.?..,',..f.,,,,!r,',,,,, ADDRESS PHONE ,, within 250 feet (1)
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ZIP ' 00eiti) Filing fell( 250 plus t5
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*When the owner and the applicant are, different per Lot)
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people, the applicant must be the purchaser of record ,
or a lessee in possession wit'ir written authorisation DATE DETERMINED TO BE, COMPLETE!
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'''''.,',11 • '." from the owner or an agent of the owner with written
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authorization. The owner(s) oust sign this
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•q application in the ..o .
he space provided on page two or FINAL DECISION DEADLINI5z,.............,......,..,
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submit a written authorization with this application.
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COMP. PLAN/ZONE DESIONAT/ON: ..
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2. PROPOSAL SUMMARY
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The owners of record of the subject property
Yr. 53 'il. request permis'sloo to divide 4 11. ':'. - N.P.O. Number: .,
(Total Area
parcel into 41 lots between ; Preliminary Plat, Approval, Dare:
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(number of lot ) ..
•: 4,600 and 7 SOO square feet in size.
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Pinal Approval Date::
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Cl e 1 Pre 1m r ary Plat) and e'p " ' .ye 'dams
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described ln.. the atta hed information sheet nt the time you submit this
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THE APPLICANT(S) SELL CERTIFY "HA
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B. If', the ePPlicet on is granted, the applicant will exercise the rights
the terms and subject to all he condi ,ions and
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granted n accordance c daJtn with ,
, " ;: limitations rtio n o the approval.df11e Jt,?t 7 tf 5* !fir
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�y11 w ^ r�. Cu l of the above statements wind the statements in the plot, plan,
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r ' 6 ;.� �. attachments, and exhibits, transmitted, herewith VO ; she he
:.1...,;,.k...6',..'..,. ,, applicants spa acknowledge that any permit isnn+ d, based on this
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application, may be revoked if it is o a d that any' such statements are
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4' i the policies and criteria* and understands the requirements fo ap rov io
� '" o denying the appltc i iod. q, t i
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