Permit SE:i4ER CONNECT I ON
CITY OF TIGARD r'ERMIT
PERMIT #.......: SWR96 -0257
DATE ISSUED: 06/24/96
'COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL.: 161 33CC—P8 3 4 1
SITE ADDRESS...: 11577 SW TALLWOOD DR
SUBDIVISION....: PEBBLECREEK #3 ZONING: R -25 •
BLOCK......... „. LOT ^41
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 - - --
COSTA PACIFIC HOMES type amount by date recpt
8625 SW CASCADE BLVD PRMT $ 2200.00 J*H 06/24/96 96- 280892
SUITE #606 INSP $ 35.00 J*H 06/24/96 96-280892
BEAVERTON OR 97008
Phone #: 646 -8888
Contractor: - --
CONTRACTOR NOT ON FILE
Phone #: $ 2235.00 TOTAL
Reg #..
RECUT RED 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, t installer shall purchase
a "Tap and Side Sewer” Permit and the )11 cy will install a lat ral.
Permittee Signature: �__ ___
Issued By: 41 11 /
/ Cal for inspection — 639 -4175
3/6/00 Activities for Case #: SWR96 -00257
12:50:03 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA010 Plan check by 5/21/96 BT2 5/30/96
SWRA020 Check for prcl. restrict. 5/30/96 BT2 5/30/96
SWRA705 Sewer Inspection BT2 5/30/96
SWRA070 Ready to issue 5/31/96 CJS PASS CJS 5/31/96
SWRA080 (F) Issue permit 6/24/96 JMH J *H 6/24/96
SWRA720 Case Finaled 11/6/96 MS PASS MRS 11/6/96 record in file
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