Permit CITY OF T SEWER CONNECTION
,4., ;, D EVELOPMENT SERVICES PERMIT
M n�� ; p PERMIT # • SWR96 -0519
�J - = --. 1 3125 SW Hall Blvd., Ti Tigard, OR 97223 503) 639 -4171 DATE ISSUED: 1 1 / 08 / 96
PARCEL: 1S136DB -02602
1 SITE ADDRESS...: 11596 SW PACIFIC HWY #OLD
SUBDIVISION • ZONING: C —G
BLOCK • LOT • •
TENANT NAME •TIRE FACTORY
USA NO • FIXTURE UNITS..•: 0
CLASS OF WORK.•.:ALT DWELLING UNITS..: 0
TYPE OF USE •COM NO. OF BUILDINGS: 1
INSTALL TYPE •BUSWR IMPERV SURFACE: 0 sf
' Remarks: SANITARY SEWER MAINLINE PREVIOUSLY EXTENDED. This permit for connectio
n.
Septic tank must be capped, filled and inspected by WAC.
Owner: FEES
PHYLLIS STEWART type amount by date recpt
621 S.W. ENGLEWOOD DRIVE PRMT $ 2200.00 JMH 11/08/96 96- 286238
INSP $ 35.00 JMH 11/08/96 96- 286238
LAKE OSWEGO OR 97034
Phone #:
Contractor:
STAT CONSTRUCTION, INC.
3605 S.W. CORBETT AVENUE
PORTLAND OR 97201
Phone #: 000 -0000 $ 2235.00 TOTAL
Reg #. • : 206269
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 Septic Tank Fill
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 the A ncy will install a lateral.
•
Permittee Signature:
Issued By:.!.4 /L,2 „,i,4 • 1
/ Call for inspection — 639 -4175,