Permit REWFR C'C1NNFCTION
PERMIT
CITY OF T DATE PERMIT
05/16/96 - 0191
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: 25104DD -02600
SITE ADDRESS...: 12873 SW RIDGEFIELD LN
SUBDIVISION • MOUNTAIN HIGHLANDS #2 ZONING: R-4.5 PD .
BLOCK • LOT •023
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
JEFF & CINDY RODGERS type amount by date recpt
10889 SW DOVER CT PRMT $ 2200.00 JMH 05/16/96 96- 279520
INSP $ 35.00 JMH 05/16/96 96- 279520
TIGARD OR 97223
Phone #: 639 -3049
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
u __ F
the date issued. The total amount paid will be forfeited if the �irir � r,L«. .
permit expires. The Agency does not gua antee the accuracy of the ill
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 fe-t in all directions from
the distance given. If not so located, he installer s . 1 purchase
a °Tap and Side Sewer° Permit and the '.eicy Vil ins a , a lateral
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M Signature: Mr. 14,46„..,' .
.I r
Issued By: ,.A ILL.' /
i. I_ .
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I Call for inspection — 639 -4175
6/9/00 Activities for Case #: SWR96 -00191
3:41:34 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA007 Application received CJS 4/29/96
SWRA010 Plan check by 4/5/96 BT2 4/26/96
SWRA020 Check for prd. restrict. 4/5/96 4/25/96 JH PASS BT2 4/26/96
SWRA705 Sewer Inspection BT2 4/26/96
SWRA070 Ready to issue 4/29/96 CJS PASS CJS 4/29/96
SWRA080 (F) Issue permit 5/16/96 JMH PAID J *H 5/16/96
SWRA720 Case Finaled 10/1/96 MS PASS MRS 10/1/96
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