Permit CITY OF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
PERMIT
n.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # - SW R97 -0071
DATE ISSUED: 05/09/97
PARCEL: 2S104DB —AH025
SITE ADDRESS... :13133 SW ROCKINGHAM PL
SUBDIVISION •AMESBURY HEIGHTS ZONING: R -4.5
BLOCK LOT •25 JURISDICTION: TIG
TENANT NAME • DALTON CONSTRUCTION INC
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: New SFD
Owner : FEES
DALTON CONSTRUCTION INC type amount by date recpt
8465 —A SW HEMLOCK ST PRMT $ 2200.00 B 05/09/97 97- 294366
TIGARD OR 97223 INSP $ 35.00 B 05/09/97 97- 294366
Phone #:
Contractor:
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 Agen wiIinstall a lateral.
• Permittee Sig tore: • G�fvj`
Issued By:
Call for inspection — 639 -4175