Permit CIPI ®F TIGARD SEWER CONNECTION . . PERM ..
PERMIT �. • n o a o„ . o S>^1R9,�-- IC"11fi�
COMMUNITY DEVELOPMENT DEPARTMENT' ,, •
� a — ={ DATE ISSUED; 04/1/93
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (5 839 -4171 •
SITE ADDRESS.- 14796 SW 81ST AVE PARCEL, 28112EtrC- 0k600
SUBDIVISION . RAZE MEADOWS ZONING: P-4.5
BLOCK .. „•., ....... ' • LOT............. :9
TENANT NAME.....: .
USA NOe 4 o n' . „ o • • FIXTURE UNITS, a e .
CLASS OF WORK, n . I NEW ' DWELL INS UNITS. -. :1 .
.TYPE OF USE, .... :SF NO. OF BUILDINGS o 1
INSTALL TYPE. a .. BUSWR PIPER SURFACE.. o u sf
• •
Remark s o PATH I .
Own er e - - - --- -- ..-. ---- - — — • - FEES — •- - -• -••
•
,T� r ICI E:LE- type , amount by date recpt
eW
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PRMT $ 2100.00 JH 04/13/93 —
�� • - ' INSP $ 35.00 00 JH 04/13,793 —
Phone ##e - • •
•
Contractor: -- - - -• -- .
CONTRACTOR NOT ON FILE • -
Phone - 4a $ , 2135.IZI! TOTAL
Reg ## . .
- — •- - - - - -•— R EOU I RED INSPECTIONS — _. - - -. —_
This Applicant agrees to cooply with all the rules and regulations Sew er Inspection
' of the Unified Sewage Agency. The peroit expires IN days fron __ __ __ -.
the date issued. The':total anoint 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 rseasurecent
oiven, the'installer shall prospect 3 feet in all directions froc _ • •� ___,_
the distance given. If not so located, the installer shall purchase ___
a ':Tap and Side Sewer' Peroit and the Agency will install a lateral. _
Perm ittep Signal;i_trea _c,�L2�� -
Issued By: ._._ _
Call for inspection — 639 -4175 -
1. . 3� 3 • �9s�,-