Permit CITYOF TIRD SEWER CONNECTION
CI?YOF WARD
COMMtNITY DEVELOPMENT DEPARTMENT \ CIOON PERM Rh1 I T
13125 SW Hall Blvd. P.O. Box 23397, Neel, Oregon 97 (603) 839-4175
\ PE # SWR93-0042
639 -4171 DATE ISSUED: 03/03/93
SITE ADDRESS ° ° °: 14268 SW WINDSONG CT PARCEL: 2S104BB -02000
SUBDIVISI ON. ° ° °: CASTLE HILL ZONING:
BLOCK LOT 047
TENANT NAME
USA NO ° FIXTURE UNI TS. ° °
CLASS OF WORK. °. :NEW DWELLING UNI TS. ° :1
TYPE OF USE :SF NO. OF BUILDINGS :1
INSTALL TYPE :BUSWR IMPERV SURFACE. °: :sf
Remarks: PATH I
Owner: FEES
DURA BUILT CONST type amount by date recpt
650 10TH ST PRMT $ 2100.00 JH 03/03/93 —
INSP $ 35.00 JH 03/03/93 —
LAKE OSWEGO OR 97034
Phone #: 635 -3816
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 2135.00 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 IN 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 e Age Ai Al install a lateral.
Permittee Signature: 11( -�t� _
Issued By:
Call for inspection — 639 -4175
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