Permit U _ 1 •
CflYOF TIQARD . •
COMMUNITY DEVELOPMENT DEPARTMENT C I Y A� SEWER CONNECTION
13125 SW Hell Blvd. P.O. Booc 23397, ligacd, Oregon 97223 (503) 639 -4175 PERMIT
PERMIT # ° SWR92 -0191 •
. 639 -4171 DATE ISSUED: 06/02/92
SITE ADDRESS— °: 11455 SW WALNUT PARCEL: 2S103AB -00600
SUBDIVISION ZONING: R -4.5
BLOCK LOT °
TENANT NAME °
USA NO ° FIXTURE UNITS. ° °:
CLASS OF WORK °..:ADD DWELLING UNITS. . :1
TYPE OF USE °SF NO. OF BUILDINGS :1
INSTALL TYPE °BUSWR IMPERV SURFACE ° ° 2 s
Remarks: Connect existing SFD to sewer. Septic tank to be pumped and filled with
sand or gravel. House constructed prior to 7 -1 -70.
Owner: FEES
WALLACE G. & EVA L. SWEENEY type amount by date recpt
11455 SW WALNUT STREET PRMT $ 300 °000 JLH 06/02/92 —
INSF' $ 35.00 JLH 06/02/92 —
TIGARD OR 97223
Phone #:
Contractor: --
G & B PLUMBING
1592 SE 51ST
HILLSBORO OR 97123
Phone #: 503- 640 - 57700 $ 335 °00 TOTAL
Reg #° .: 19907
REQUIRED INSPECTIONS
This Applicant agrees to cooply with all the rules and regulations Sewer Inspection -
of the Unified Sewage Agency. The permit expires 180 days frog Septic Tank Fi 11
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 aeasureaent
given, the installer shall prospect 3 feet in all directions fro:
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 Signature:
Issued By: //A—...) T --
Call for inspection — 639 -4175
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
/
Inspection Line (Rec- O- Phone): 639 -4175 Business Phones 639 -4171
Inspection:
Footing Plbg. Underslab Mech. Rough -in Appr /Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post /Beam Struct. San. Sewer] Framing -Bldg.
Post /Beam Mech. Rain Drain Insulation - Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: !6i ^ q - Time: /` AM PM
// � 1 _ /t //
Address: Permit `� — � Q Permit I:
Builder:
THE FOLLOW' CO RRECTIONS ARE REQUIRED:
/ 2 / /'
C ... 0 " ... ,
/7.‘Z/ -- 4 ....
Inspector: Date: Lre"
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
+• ALOHA SANITARY SERVICE
P.O. BOX 309, BANKS, OREGON 97106
644 -2797 / 648 -6254 / 324 -4343 / 639 -5188
NAME
ADDRESS
PHONE HOME WORK
JOB SITE
CHARGE � " PAID BBC CHECK' . ; :- -CASH VISA D
DATE , • DRIVER
.. • #' i i - i!, AMOUNT
-
- REMARKS -
-
-; TYPE OF TANK: STEEL I CONCRETE / PLASTIC / OTHER
HORIZONTAL / VERTICAL / RECTANGLE I OTHER
SIZE OF TANK: 350 / 500 / 750 / 1000 / 1250 1 1500
LID LOCATION: INLET / OUTLET / MIDDLE / OTHER
CONDITION OF TANK: GOOD / FAIR / POOR
FITTINGS: BAFFELS / CONCRETE / CAST IRON / PLASTIC
NEEDS NEW LID ❑ SIZE
GROUND COVER OVER TANK
COMMENT ON CONDITION OF DRAINFIELD ETC.
RECEIVED BY
TOTAL
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