Permit CITi � TIGARD
SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT
13125 SW Hall Blvd Tigard, Oregon 97223.8199 (503) 639-4171 � ' ' PERMIT # ^ SWR94-0193
639-4171 DATE ISSUED: 12/27/94
PARCEL: 1S133CC-01800
SITE ADDRESS...: 11667 SW TALLWOOD LN
SUBDIVISION....: PEBBLECREER ZONING: R-25
BLOCK..........: LOT— ..... ..... :012
___________
TENANT NAME.....
USA NO..........: FIXTURE UNITS...:
CLASS OF WORK..`. :NEW DWELLING UNITS.. :1
TYPE OF USE. . . . . :SF NO. OF BUILDINGS:1
INSTALL TYPE. ...:BUSWR IMPERV SURFACE..: :s
Remarks: PATH I
Owner: FEES
________ _________ _ __
COSTA PACIFIC HOMES type amount by date recpt
14780 SWO SPREY DR PRMT $ 2200.00 KS 12/27/94 —
# 275 INSP $ 35.00 KS 12/27/94 —
BEAVERTON OR 97007
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 Ag»ncy. The peroit eipires 180 days fron ___
the date isuod. The total anount paid will be forfeited if the
peroit 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 l,catod, the installer shall purchase _ _
a "Tap and Side Sower" Peroit a d the Agency will inst.. ' ate .
4�', ---------- ------ ---------' -----
Permittee Sig a,
—
Issued By: _ _ __________ _ ____________
Call for inspection — 639-4175