Permit CITYOF TINA RD 14.
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if C OMMUNITY DEVELOPMENT DEPARTMENT CIiY o ,,, SEWER CONNECT ION
13126 SW Hell Blvd. P.O. Box 23397, Tigard, Oregon 97223 (603) 639 -4176 PERMIT
PERMIT
639 -4171 DATE ISSUED: 02/18/93
SITE ADDRESS...: 12492 SW WINTER LAKE DR' PARCEL: 1S134CC -03400
SUBDIVISION ° CAPSTONE ZONING: R -4.5 PD
BLOCK LOT •1
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
J ALLAN PATERSON type amount by date recpt
12700 SW PACIFIC HWY PRMT $ 2100.00 JH 02/18/93 —
INSF $ 35.00 JH 02/18/93 —
TIGARD OR 972:3
Phone #: 639 -3828
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 2135.00 TOTAL
Reg #.. .
REQUI RED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
of the Unified Sewage Agency. The permit expires 1B® days from
the date issued. The total amount paid will he 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 lateral.
Permittee Signature: , y _I
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Issued By :c /
Call for inspection — 639 -4175
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