Permit SEWER CONNECTION
1 :::11171( (DI T PERMIT #PERMIT ° SWR95 -0222
COMMUNITY DEVELOPMENT [SE 1I1iENT DATE ISSUED: OG / 14 / 9
Al
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL : 291 04CD— i 0400
SITE ADDRESS...: 13649 SW TRACY PL
SUBDIVISION ° HILLSHIRE ESTATES NO. 2 ZONING: R -7 PD
BLOCK LOT -103
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
WINDWOOD HOMES type amount by date recpt
14076 SW BENCHVIEW TERR. PRMT $ 2200.00 JD 06/14/95 95- 266728
INSP $ 35.00 JD 06/14/95 95-- 266728
TIGARD OR 97224
Phone #: 590 -4700
Contract or:
CONTRACTOR NOT ON FILE
Phone #: $ 2235.00 TOTAL
Reg L. °
REQUIRED INSPECTIONS
This Applicant agrees to cooply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 180 days fro:
the date issued. The total mount 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 oeasureoent
given, the installer shall prospect 3 feet in all directions froo
the distance given. If not so located, t - installer shall purchase
a Tap and Side Sewer° Peroit and the 'y will install a lateral.
Permittee Signature: �.__�J� _
Issued s� - . ___ G
Call for inspection — 639 -4175
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