Permit CITY OF T SEWER CONNECT I ON
A „,, DEVELOPMENT SERVICES PERMIT a�, l ,PERIYlIT . # #a ,.., . 5WR97 - 0053
' LL 13125 SW Ha11.Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 02/28/97
• F' i RCEL,e ., 1 S 12, L A- 1 •
SITE ADDRESS— e e 06620 SW KINGS') I EW CT
SUBDIV a >, CHARLES., ESTAT,Ea . • , , „ ZON.I NG r.., R-4.5 ,
BLOCK.aa — -- LOT. - o o.aoo. . :006 .
TENANT NAME — -. - :TOM ROGERS CONSTRUCTION LLC
USA NO. . e n . - - • ' . -,' , FIXTURE UNITS... o 0
' CLASS OF WORK... :NEW DWELLING UNITS.. 1
TYPE OF USE.- b . n :,SF ., , I , ; NO.- OF BUILDINGS:, ,. 1
INSTALL TYPE-- - . :DUSWR IMPER'V SURFACE: 0 sf
Remarks: Path 1
Owner : .. . - . , , . FEES,. .
TOM ROGERS CONSTRUCTION LLC type amount by date recpt
PO BOX 8105: , . , . , • . _ _ ,. -.:. PRMT $..2200.00 JMH 02/28/97 97- 291024
INSF' $ 35.00 JMH 02/28/97 97- 291024
PORTLAND OR 97280
Phone . #a. 6847 1193...,, .,
Contract or: --- _.--- .__-- ._. -___ •
CONTRACTOR NOT ON FILE
Phone %e $, 2235.00 TOTAL
Reg # =a:
. 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 he forfeited if the .
permit expires. The Agency does not 'guarantee the accuracy of the ,
side sewer °laterals.. If • the; tsewer. . is' Finot- :located at 'the measurement . '
given, the installer- . shall'prospect 3•feet.,in al.l' directions from _ _
the distancelrgiven. If not - so' located, the iristallerr shall purchase- .. . _ .
a "Tap. and 'Side -Sewer” Pereitr:and. the A _ wi 1° install,. a' lateral, .
- —
Permit Signet ure: lf _ _ __' ..
Issued By: _�� iG �, '. • , .,, �_�.
- Call for inspection,- 639 -4175