Permit 1
SEWER CONNECTION
1. e rry OF TIGARD ,
PERMIT * PERMIT
- SWR95-0320 '
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/09/95
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 26104CD -1 O000
SITE ADDRESS...: 13652 SW TRACY PL
SUBDIVISION....: HILLSHIRE ESTATES NO. 2 ZONING: R -7 PD
BLOCK........... LOT........ ..... :099
• 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
WINDWOOD CONSTRUCTION, INC type amount by date recpt
6933 SW TIERRA DEL MAR PRMT $ 2800.r<00 B 08/09/95 95- 269006
INSP $ 35.00 B 08/09/95 95- 269006
BEAVERTON OR 97007
Phone #:
Contractor •— - - - --
CONTRACTOR NOT ON FILE
Phone #: $ 2235.1Z10 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 froo
the date issued. The total aoount paid will be forfeited if the ___
perait expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the oeasureoent
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" Peroit and the Agency will install a lateral. _
—
Per Si nature: MA _�_ -_
Issued By: . _. ___
Call'for inspection — 639 —•4175 '
q s — g qp