Permit CITY OF T SEWER CONNECTION
J 7 1 DEVELOPMENT SERVICES PERMIT —
-411 PERMIT # SWR97 -0017
._' =:_.. 13125 SW HaII Blvd., Tigard, OR 97223 (503)639-4171 639.4171 DATE ISSUED: 02/11/97
PARCEL: 25109AA —WH001
SITE ADDRESS...: 12905 SW WILMINGTON LN
SUBDIVISION • WILMINGTON HEIGHTS ZONING: R -7
BLOCK • LOT :001
TENANT NAME •CHI DANG
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 1
Owner: FEES
CHI DANG type amount by date recpt
11006 SW 81ST AVE PRMT $ 2200.00 JSD 02/11/97 97- 290220
INSP $ 35.00 JSD 02/11/97 97- 290220
TIGARD OR 97223
Phone #: 639 -9839
Contractor • _
CONTRACTOR NOT ON FILE
Phone #: $ 2235.00 TOTAL
Reg #..
REQUIRED INSPECTIONS
This Applicant, agrees to comply with all the rules and regulations Sewer ,Inspection
of the Unified Sewage Agency. The permit expires 18S 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.
� n
Permittee Sigma., - -.
Issued By:
4
Call for inspection,,— 639-4175,