Permit CI11( T I GARD
COMMUNITY DEVELOPMENT DEPARTMENT SEWER CONNECTION
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PERMIT
PERMIT # ° SWR94 -037E
639 -4171 DATE ISSUED: 11/29/94
• PARCEL: 2S114A0 —WE012
SITE ADDRESS. „ °: 08887 SW WAVERLY DR
SUBDIVISION • WAVERLY ESTATES ZONING: R -12
BLOCK ° LOT °012
•
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 --
R&W PARTNERS type amount by date recpt
12540 SW 68TH PRKWY PRMT $ 2200.00 JF 11/29/94 —
SUITE B INSP $ 35.00 JF 11/29/94 —
TIGARD OR 97223
Phone #: 503• - 639 -2639
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 free _
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 sewerois not located at the measurement
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' Permit and the Agency will install a lateral.
Permittee Si gnat ure11:icy�r
Issued By: -- --
Call for inspection — 639 -4175
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