Permit CITY OF TIGARD
DEVELOPMENT SERVICES PERMIT
SEWER
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PERMIT # • SWR97 -00E,9
DATE ISSUED: 04/25/97
PARCEL: 2S104DB —AH046
SITE ADDRESS...:13158 SW ROCKINGHAM DR
SUBDIVISION •AMESBURY HEIGHTS ZONING: R -4.5
BLOCK LOT •46 JURISDICTION: TIG
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: Single family new residence
Owner: FEES
LONE MOUNTAIN CONSTRUCTION type amount by date recpt
1315 NW 185TH AVE #194 PRMT $ 2200.00 JMH 04/25/97 97- 293768
BEAVERTON OR 97006 INSP $ 35.00 JMH 04 /25/97 97- 293768
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 The permit expires 188 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 in aller shall pu ase
a °Tap and Side Sewer" Permit and the Agenc will ins 11 .teral.
Permittee Signature: 14/i
Issued By: ilik_ / _%i. ► .
/ 1 1 r.., ..._rte - �.., — 639 -4175