Permit ,,
S EWER CONNECTION
.CITY OF TIGARD PERMIT
PERMIT # • SWR96 -0351
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 07/30/96
13125 SW Hell Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 2S104DD -02000
SITE ADDRESS...: 12876 SW RIDGEFIELD LN
SUBDIVISION MOUNTAIN HIGHLANDS ZONING: R -4.5 PD
BLOCK • LOT -017
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 1
Owner: FEES
DAVID SCHWERDT type amount by date recpt
9407 SW MAPLEWOOD DR 4417138 PRMT $ 2200.00 JSD 07/30/96 96- 282317
INSP $ 35.00 JSD 07/30/96 96- 282317
TIGARD OR 97223
Phone #: 620 -5404
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 2235.00 TOTAL
Reg #.. .
REQU I RED I NSPECT IONS
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 h• '.uenc 1 will i tall a lateral.
P'ermittee Signatures �� � ' � /��
Issued may- �` /
Call for inspection — 639 -4175