Permit CI1Y OF TIGARD SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT
PERMIT #
13125 SW Hail Blvd. Tigard, Oregon 97223.81 9 03 8 1a�11 171 5WR93 -0438
+ DATE ISSUED: 10/20/93
PARCEL: 2S104AC -05200
SITE ADDRESS °..1 12772 SW 133RD AVE
SUBDIVISION ° MORNING HILL 8 ZONING: R -25
BLOCK ° LOT °. °. ° ° ° ° ° °..° :196
TENANT NAME °
USA NO FIXTURE UNITS °. °:
CLASS OF WORT'.° ° ° :NEW DWELLING UNITS ° .: 1
TYPE OF USE °SF NO. OF BUILDINGS :1
INSTALL TYPE.... :BUSWR IMPERV SURFACE..: :sf
Remarks: PATH I
Owner: - -• -- FEES
FRED BULLER type amount by date recpt
3260 SW SHERWOOD PL PRMT $ 2200.00 PLL 10/20/93 —
INSP $ 35.00 PLL 10/20/93 —
PORTLAND OR 97201
Phone #: 223 -4499
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 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 nstaller shall purchase
a "Tap and Side Sewer" Permit and theJ'-n. will i - 1 a late•al.
/J
Permittee Signature: 't' I 4.4 !Al c.
Issued By: i aL/
Call for inspection — 639 -4175
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