Permit ' CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT SEWER CONNECTION
1n1usSw Hall Blvd. Tigard, Oregon 97223°819e (503) e3e-4171 PERMIT
PERMIT #...... GWR94-0407
639-4171 DATE ISSUED: 12/30/94
PARCEL : 2S109BA—HS005
SITE ADDRESS...: 13917 SW LEAH TERR
SUBDIVISION....: HILLSHIRE SUMMIT ZONING: R-7 PD
BLOCK ....^.....: LOT. ... ........ .:005
_
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..: :
Remarks: PATH I
Owner: ----- — — — --- FEES
J B & BN CONSTRUCTION, INC type amount by date recpt
P 0 BOX 1784 PRMT $ 2200.00 JF 12/30/94 —
INSP $ 35.00 JF 12/30/94 —
LAKE OSWEGO •
Phone #:
Contractor: --------- —
CONTRACTOR NOT ON FILE
•
Phone #: $ 2235.00 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 100 days froo _
the date issued. The total ouount paid will be forfeited if the
peroit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measoreoout
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 S the ' lateral.
.
Permittee Signature
e ~.— --_ -----' -- --- ---
^�
Issued By �., _ _ •
Call for inspection — 639-4175 •
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44- Vt �� --�