Permit SEWER CONNECTION
CITY OF T 'ER
COMMUNITY DEVELOPMENT DEfrAFIWIENT DATE ISSUED: 06/15/95
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 1S1260C- 01107
SITE ADDRESS...: 09625 SW WASHINGTON SQUARE RD
SUBDIVISION ZONING: C —G
BLOCK........... LOT
TENANT NAME °EDO JAPAN
USA NO........,,.: FIXTURE UNITS... :19
CLASS OF WORK... :ALT DWELLING UNITS.. :1
TYPE OF USE -COM NO. OF BUILDINGS:
INSTALL TYPE.... :BUSWR IMPERV SURFACE..: :sf
Remarks: Restaurant TI
Owner: - - -- • -- -- - - - - -- FEES
L AND M DEVELOPMENT CORP. type amount by date recpt
3335 PARK DRIVE PRMT $ 2200.00 SW 06/15/95 —
COLUMBIA CITY OR 97018
Phone #: 397 -0779 •
Contractor: --
CONTRACTOR NOT ON FILE
Phone #: $ 2200.00 TOTAL
Reg L. .
- - - - - -- REQUIRED INSPECTIONS - --
This Applicant agrees to comply with all the rules and regulations Sewer Inspection _
of the Unified Sewage Agency. The permit expires 180 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.
J
Permittee Signature:. . i .6,
Issued Bye
r.
Call for inspection — 639 -4175
•
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