Permit CITY OFTIGARD
, DEVELOPMENT SERVICES SEWER CONNECTION
i' Vi I�' PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171
PERMIT # • SW R97 -0091
DATE ISSUED: 05/13/97
PARCEL: 2S104DD -06900
SITE ADDRESS.••:12811 SW RIDGEFIELD LN
SUBDIV:'SION •MOUNTAIN HIGHLANDS NO.3 ZONING: R -4.5
BLOCK......„.... LOT :027 JURISDICTION: TIG
TENAN: NAME !FOUR D CONSTRUCTION
USA NO • • FIXTURE UNITS...: 0
CLASS OF WORK.—:NEW DWELLING UNITS..: 1
TYPE OF USE -SF NO. OF BUILDINGS: 1
INSTALL TYPE •BUSWR IMPE:•AI SURFACE: 0 sf
Remarks: New SFD
Owner: FEES
FOUR D CONSTRUCTION CO type amount by date recpt
PO BOX 1577 PRMT $ 2200.00 JMH 05/13/97 97- 294495
BEAVERTON OR 97075 INSP $ 35.00 JMH 05/13/97 97- 294495
Phone #:
Contractor:
OWNER
Phone #: $ 2235.00 TOTAL
Reg #.. :
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
of the Unified Sewage Agency. The permit expires 180 days from
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 Agenc wil install : . •r
Permittee Signature: / : ice `
`�, 7 ,
Issued B y: V. _ __..4&_„, _ _" / :4a _LJ41A.. 4. 4 —._—
Call for inspection — 639 -4175
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5 /10 /99 Activities for Case #: SWR97 -00091
3:04:27 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA007 Application received 3/25/97 JSD - PASS PHN 3/28/97
SWRA705 Sewer Inspection 7/29/97 MS PASS J'H 8/20/97
SWRA080 (F) Issue permit 5/13/97 BON PASS JD 5/21/97
SWRA720 Case Finaled 7/29/97 MS PASS J *H 8/20/97
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