Permit CITY OF TIGARD
DEVELOPMENT SERVICES SEWERPCONIECTION
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PERMIT # SWR97 -0162
DATE ISSUED: 06/16/97
PARCEL: 2S1O4DD -06800
SITE ADDRESS...:12823 SW RIDGEFIELD LN
SUBDIVISION •MOUNTAIN HIGHLANDS NO. 3 ZONING: R -4.5
BLOCK LOT -026 JURISDICTION:
TENANT 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 IMPERV SURFACE: 0 sf
Remarks: Single family new residence
Owner: FEES
FOUR D CONSTRUCTION type amount by date recpt
PO BOX 1577 PRMT $ 2200.00 B 06/16/97 97- 296050
BEAVERTON OR 97075 INSP $ 35.00 B 06/16/97 97- 296050
Phone #:
Contract or:
OWNER
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 purchase
a °Tap and Side Sewer° Permit and the Agency will install a lateral.
ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 -0010 through OAR 952- 0001 -0080. You may obtain copies of
these rules or direct uestions to OUNC by calling (503)246 -1987.
i
Issued by: � ^� Permittee Signature: _ , !,
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Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
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6/30/99 Activities for Case #: SWR97 -00162
1:30:26 PM
Assigned Hold Updated •
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes •
SWRA007 Application received 3/26/97 JMH RECD DRA 5/23/97
SWRA705 Sewer Inspection 7/29/97 MS PASS J'H 8/20/97
SWRA070 Ready to issue 6/16/97 B PASS BON 6/16/97
SWRA080 (F) Issue permit 6/16/97 B PASS DST 6/16/97
SWRA720 Case Finaled 7/29/97 MS PASS J'H 8/20/97
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