Permit M • 0
CITY OF TIGARD PERMIT
PERMIT # • SWR96 -0266
DATE ISSUED: 06/10/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: 251 1 1 AB -00400
SITE ADDRESS...: 09100 SW MC DONALD ST
SUBDIVISION • ZONING: R -4.5
BLOCK • LOT •
TENANT NAME
USA NO • FIXTURE UNITS...: 0
CLASS OF WORK...:NEW DWELLING UNITS..: 1
TYPE OF USE -SF NO. OF BUILDINGS: 1
INSTALL TYPE •BUSWR IMPERV SURFACE: 0 sf
Remarks: PATH I
Owner: FEES
JOYCE OLSON type amount by date recpt
24195 SW BOONES FERRY RD PRMT $ 2200.00 JSD 06/10/96 96- 280408
INSP $ 35.00 JSD 06/10/96 96- 280408
TUALATIN OR 97062
Phone #: 682 -7712
Contract or:
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 fro■
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" Permit and ti- 'g:ncy will install a lateral.
Permittee Signature: d ')
Issued •••1"— > i 4 `r
Call for inspection — 639 -4175