Permit SEWER CONNECT I ON
CITY OF TIGARD: ,„ , 4•:'.i:iu;a
l�L;�ii *s .I ,' =V -° 5WR93:-- al
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW HaII,Blvd. Tigard, Oregon 97223.8199 (503),639171 WYE 1 f Si; D n lii; , i 29 /93
S: 1 T, 'ADD RESS. e e g 11883 SW 127T in . PL • ' • PARCEL 1 S 33DD— i'tt•20Zi
;U3D1 i• A. S 10i\i.., o u g ' V J LL(GE AT :iLi L(; <.E FPFiRI A .4 . • ZONING:; R -4� 5 •
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EI:Ai4 i i`vAME.. .
USta. NO e F.I"XTiJRE' L .
CLASS OF. WORK... o NEW .. . DWELL 11\10 UN i T S„ . .41
, I 'r PE OF USE .4`14 NO. OF LtiU I LD I NGS_o 1
. INSTALL TYPE.— . ] E-1U WR' . I MPE RV .SURFACE.. P. . F. S
Remark s g • - FAR T !-s. I • r - , • ,
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r - EicS
: JCi;' ! FOR ISSE_'T TE HONES . : type acioun t . by date ' r ^ecp
i5.�35 .S W BANG ,Y RD pix i T " S 210 t(_I' J :6-I 06/29/93 , •
U I I E •'Y .Eb 1 •• I KIS'P 't . 35'. 00 JH-i tE: / . 9 /93 e .
LAKE JSWIGO OR 97035' "
CONTRACTOR" MJT Oi' FILE .
. P li a n e #I $ 2 :i 3;5. 0 0 "F O T ; L " - _. _
I a g' .4*. a .
-- . REQUIRED D I NSPECT IONS
This k�Rlicant :agrees to cocply kith all the rules ant: Seoul ,lions• Sewer inspection • .
' the Unified Kaae Aoercb, Tile pErr;it expire- •I L nays frr;a .
•
— - -`.; f3 cage issad. T,,e total ac:u It_paid'_r:ili: to forfeited if the -
p- n=; Eiip re.s. :he Agency does no - i. guar°ar.tee the accuracy of the
side
see latuals. if the 'serier is not located at ti. neasLre:e'it •
given tae installer; s;rail prospect 5 feet in ali directions frog • -
d
the distance given. .If sot sc located the :ry s r aller shall purchase • _
a °Iap and Side Sewer' Pernat and tr: Agency till instal :.a lateral. '
ateral. . .
I
t-'' S rlrrature - .— fr,f2 - .•
Issued Sy __ _ .. . . •
. • . Call for inspection — 639 -4175 :
.
o? � /� 7 .x.3: .