Permit CITY OF TIGARD SEWER CONNECTION
PERMIT
• PERMIT # • SWR96 -0374
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 09/11/96
13126 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 29104DD -02200
SITE ADDRESS...: 12858 SW RIDGEFIELD LN
SUBDIVISION • MOUNTAIN HIGHLANDS #2 ZONING: R -4.5 PD
BLOCK • LOT :019
TENANT NAME •
USA NO • FIXTURE UNITS...: 0
CLASS OF WORK...: DWELLING UNITS..: 0
TYPE OF USE • NO. OF BUILDINGS: 0
INSTALL TYPE • IMP'ERV SURFACE: 0 sf
Remarks: Path I
Owner: FEES -----
BETTER BUILD HOMES type amount by date recpt
PO BOX 567E PRMT $ 2200.00 B 09/11/96 96- 283811
INSP $ 35.00 B 09/11/96 96- 283811
BEAVERTON OR 97006
Phone #: 648 -5401
Contractor:
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 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 p ase
a 'Tap and Side Sewer° Permit and the Agency -ill stall) a aater%. —
Permittee Si nature: , _ f�''_/�, - __ y
Issued By: -■ (tip
______
Call for inspection — 639 -4175
5/23/00 Activities for Case #: SWR96 -00374
2:58:19 PM
Assigned Hold Updated •
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA007 Application received 7/25/96 JH RECD BON 8/2/96
SWRA010 Plan check by 8/2/96 BON 8/2/96
SWRA020 Check for prcl. restrict. 8/2/96 BON 8/2/96
SWRA705 Sewer Inspection 6/11/97 BB PASS JT 5/7/98 storm sewer
SWRA070 Ready to issue 8/13/96 CJS PASS CJS 8/13/96
SWRA080 (F) Issue permit 9/11/96 B PASS BON 9/11/96
SWRA720 Case Finaled 5/7/98 JT 5/7/98
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