Permit 1,4.
CITYOF TI RD 4;11 SEWER CONNECTION
C11YOF111rrARD PERM I T
COMMUNITY DEVELOPMENT DEPARTMENT \ �+ / PERMIT # ° SWR9 —0097
13135 SW Hall Blvd. P.O. Box 23397, Tigard, Oregon 97223 (503) 63134175 \
•
639 -4171 DATE ISSUED: 03/03/93
SITE ADDRESS...: 14097 SW LIDEN DR PARCEL: 2S104BB -04300
SUBDIVISION • CASTLE HILL ZONING:
BLOCK LOT • 024
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
MLADEH BAR ICEVIC type amount by date recpt
10480 EASTRIDGE #106 PRMT $ 2100.00 JH 03/03/93 —
INSP $ 35.00 JH 03/03/93 —
PORTLAND OR 97225
Phone #: 292 -5915
Contractor:
CONTRACTOR NOT ON FILE •
Phone #: $ 2135.00 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 he 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" Permit and the Agency will install a lateral.
Permittee Signature: G�
Issued By:
CalI for inspection — 639 -4175
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