Permit SEWER CONNECT I ON 11
PERMIT
CITY OF TIGARD *PERMIT DATE ISSUED: 02./28 -064
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PARCEL: :5 104CD -1 0300
' SITE ADDRESS...: 13633 SW TRACY PL
SUBDIVISION....° HILLSHIRE ESTATES NO. 2 ZONING: R -7 PD
BLOCK LOT .102
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 I
Owner: FEES -----
W I NDWOOD HOMES type amount by date recpt
14076 SW BENCHVIEW TERRACE PRMT $ 2200.00 JSD 02/28/96 96 -276414
INS1 $ 35.00 JSD 02/28/96 96- 276414
TIGARD OR 97224
Phone #: 590 -4700
Contractor: --
CONTRACTOR NOT ON FILE
Phone #: $ 2235.00 TOTAL
Reg #.. .
- -• REQUIRED INSPECTIONS
This Applicant agrees to cooply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The peroit expires 180 days froo
the date issued. The total aoount paid will be forfeited if the
peroit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the neasurenent
given, the installer shall prospect 3 feet in all directions froo
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer" peroit and the Agency will install a lateral.
Permittee S' re: Q i_ _ -
, 4110 4.110
Issued a '` __
Call for inspection — 639 -4175
Cite.— 2 --1/CoC4 I