Permit CITY OF TIGARD SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT
' 13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PERMIT # SWR93- 0508
639 -4171 DATE ISSUED: 01/18/94
PARCEL: 2S10400 —HE065
SITE ADDRESS...: 13658 SW WHITE CEDAR PL
SUBDIVISION • HILLSHIRE ESTATES ZONING: R -7 PD
BLOCK LOT •065
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..: :sf
Remarks: PATH I
Owner: FEES
SHELBURNE DEVELOPMENT type amount by date recpt
7008 SW NYBERG RD PRMT $ 2200.00 JF 01/18/94 —
INSP $ 35.00 JF 01/18/94 —
TUALATIN OR 97062
Phone #: 692 -6383
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 160 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 Signature:
Issued By:
Call for inspection — 639 -4175
�L/7 77-