Permit i
CITY O TIGARD SEWER CONNECTION
i , DE VELOPMENT SERVICES PERMIT
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # : SWR96 -299
DATE ISSUED: 11/15/96
PARCEL: 15133CC —PB343
SITE ADDRESS...: 11541 SW TALLWOOD DR
SUBDIVISION..: PEBBLECREEK #3 - ZONING: R -25
B.LOCK........... LOT ............. :43
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 : -- -- - - - - - --
COSTA PACIFIC HOMES type amount by date recpt
8625 SW CASCADE BLVD #606 • PRMT $ 2200.00 DRA 11/15/96 96- 286588
INSP $ 35.00 DRA 11/15/96 96- 286588
BEAVERTON OR 97005
Phone #: 646 -8888
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
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 Agency will install a lateral.
,� �.
Permittee iyn ure :i / /�:'!;/!► _` _ _ __
4
Issued B : ‘_. ___
Call for inspection - 639 -4175
5/9/99 Activities for Case #: SWR96 -00299
8:44:07 PM •
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA010 Plan check by 6/7/96 BT2 6/17/96
SWRA020 Check for prcl. restrict. 6/7/96 6/14/96 BON PASS BT2 6/17/96
SWRA705 Sewer Inspection BT2 6/17/96
SWRA070 Ready to issue 6/18/96 CJS PASS CJS 6/18/96
SWRA080 (F) Issue permit 11/15/96 DRA PASS DRA 11/15/96
SWRA720 Case Finaled 1/8/97 MS PASS MRS 1/8/97
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