Permit CITY OF T CONNECTION J
PERM I T
PERMIT .�4a „�a4 SWR95 0137
COMMUNITY DEVELOPMENT DEPARTMENT
oc , r1 e ,. DATE ISSUED: 04/06/95
13125 SW Hall Blvd. Tigard, Oregon 9722308199 (503) 639 -4171
PARCEL: 15133CC -01300
SITE ADDRESS...: 11735 SW TPLLWOOD DR
SUBDIVISION....: PEBBLECREEK ZONING: R -25
BLOCK.....'—...: LOT,,,.. .....e.:0 7
TENANT NAME.....:
USA NO..........: FIXTURE UNITS..
CLASS OF WORK.. ,. o NEW DWELLING UNITS.. . 0 1
TYPE OF USE,.., s SF NO. OF BUILDINGS: 1
INSTALL TYPE....: BUSWR IMPERV SURFACE..: ; sf
Remarks: PATH I
Owner: -------- _.— __.__.__.__----- _._____.._____ FEES ______
COSTA PACIFIC HOMES type amount by date recpt
14780 SW OSPREY DR PRMT $ 2200.00 B 04 /06 /95 —
SUITE 44 275 INSP $ 35,0121 B 04/06/95 --
BEAVERTON OR 97007
Phone #: 646 -8888
Contractor: --------------- ______
CONTRACTOR NOT ON FILE
Phone #: $ 2235.00 TOTAL
Reg 4$o . a .
—__ REQU I RED I NSPECT I ONS
This Applicant agrees to conply with all the rules and regulations Sewer Inspection _ ____
of the Unified Sewage Agency. The peroit expires 185 days fro _____ _ _
the date issued. The total amount paid will be forfeited if the ^. , . _._._.____.____....__.v
permit expires, The Agency does not guarantee the accuracy of the . „ ____. _ .__ _ _
side sewer laterals. If the sewer is not located at the oeasureoent
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 a the Agency will install a lateral. _ ___ _ —
Perm ittee Si gnat �.►re ._.. � — -� _ _ _- �. .- —
_ — __.__.._..._-- ---_-_., __._._._— .._ __- ____.— ._._....._..�.._...-. e _ — ��
Issued B y e --._.._ __
Call for inspection — 639 -4175
5 —` '3 61 3gg,