Permit CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2001 -00315
61— 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/31/01
SITE ADDRESS; 11259 SW 84TH AVE PARCEL: 1S136CB -ACM12
SUBDIVISION: ASH CREEK MEADOWS ZONING: R -12
BLOCK: LOT: 012 • JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection permit for new SF residence.
Owner: FEES
ESLINGER BUILDERS INC Type By Date Amount Receipt
11575 SW PACIFIC HWY.
PMB160 PRMT CTR 12/31/01 $2,300.00 27200100000
TIGARD, OR 97223 INSP CTR 12/31/01 $35.00 27200100000
Phone: 503 - 620 -9515 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
•
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
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" Perm
Issued by: -(" � ,� � /( t Permittee Signature: \d j
mot` /� l i � e zL
Call (503) 494175 by 7:00 P.M. for an inspection needed the next business day