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15335 Sint ALDERHROOK CIRCLE
/-,7C
r --� SEWER PERMIT N 5 4
Unified Sewerage Agency
of Washington County CITY OF Tivard DATE
OWNER : Q.D. C . P H 0 N
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
h1,Z&UII_DING SEWER �� BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
NEW B;SING1_E FAMILY ❑ COMMERCIAL
❑ EXIST. (PRIOR TO 7- 1-70 ) [] MULT. RES. ❑ INDUSTRIAL.
FIXTURE UNITS---- DWELLING UNITS_—.1
ADDRF'-S OF STRUCTURE :
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RUt.ES ^,ND
REGU'_ATIONS OF THE UNIFIED SEWFgAGE AGENCY. WHEN CALLING FOR INSPECTION,
PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION 1_XPIRFS IN ONE-
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR.
FEES:
PERMIT FEE $ 25.
CONNECTION CHARGE 600.
SIDE SEWER INSTALLATION _
ISSUED BY
OTHER
'TOTAL $ 625.
APPLICANT DATE
SEWER PERMIT � �► 15849
ADDRESS OF STRUCTURE 15335 SW A] derbrook Circle
TAX MAP — "TAX LOT _ SYSTEM _ �fennu creek
LOT 490 BL;ICK ___-- —� OF
APPROVFD BY DATF ISSUED Eli
D . U. 'S 1 REMARKS bldg. #2009
�.�.. _....,._. '" ,_ • ._ .,.. ...e..qr!�+e7YMM'w.yyrP^.r.-._;,,,.�.,,,.-�..�.....q•.-...y..�...,rr _.._....`I•�oa6�gr-....
BUILDING PERMIT APPLICATION 11T TIGARU DATE 4-7-70 2�Iu =�
OF
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONF.—_
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OVVNERPHONF _
Or. !.• �. .1 t G i�: LOT NO._ --
OWNER
JOB ADDRESS 11 33•., JI. H1derbrook HOME ADDRESS
;+�� � ARCHITECT
ENGINEER
BUILDERyy ADDRESS DESIGNER
rLJ
STRUCTURE BNEW ❑REMODEL ❑ADDITION UREPAIR ❑FIENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑RESIDENCE ❑COMM ❑EDUCATIONAL 0GOV-T ❑RELIGIOUS❑P-kTIO ❑CAR POFIT ❑GARAGE ❑STORAGE❑SLAEI ❑FENCE
❑BOND– ❑MOVING ❑CONDITIONAL USE_ ❑DESIGN REVIEW000UNCIL APPROVED ❑SIGNS
OCCUPANCY _.LAND USE ZONE---BLDG.TYPE._ .J d FIRE ZONE—� PLAN CHECK BY_ 91�1,I HEAL--
-- L�It A'� i ISIi•. clic!'Us 0400 4S 15613 ',1 5Ui'k1M8Vfiml.d Lc
RAWARexpr rmAt *over jjwalnl�..15649_
OCC�1,4A2___—FLQy�L4�. 1--_.--. -H-EllC��T__ �p NQ.$ISFiI _ Z AREA20 �I_1�SL9�l2H4QM '�--- YBlSJ 3�ULll��
BUILDING DEPARTMENT LEFTSIDE DE U RIGHT SIDE
Permit �.J
SET BACKS FRONT REAF ��
��; r. .._
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING
Plan Check (�0 REGULATIONS ANC ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL OF OC;'� IN ACCORDANCE WITH THE PI.ANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal 6 00 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCL? OF THIS PERMIT DOES 'NOT WAIVE
•6d RESTRICTIVE COVENANTS. CON1'NACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State rax L#CEMS - SEP4 PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
I"utal IU2.64 0,U.C. #2 Sion),.
By
APPL.[CANTOR-AGENT------
Approved
GtNt-- _Approved 011 Receipt No. .
i
9
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DATE IIMSP. TYPE INSPECTION REMARK! PLUMBING -- DNTE _
Contractor
Permit No.
Rough-in — —
61 --- Fixture — —
Final _ --
,� � HEATIfJq
Contractor
-- Permit No. 1 1 1 —
W-z -7 8
------ Gas or Oil—___1._i__
-- --_ ----------- Rough-in--- —
Anal -
SE4JER
DRIVEWAY
Final
Stoom Drainage
—J (Rain Drain) Final
— — Sidewalk
—^ — Curb&Strent Final
--- ---- rLnnaicaping
h
BL DO. ORPT. FINAL TEMPORARY ����CERTirwATE O' : .1PANCY -- r—
CERTIFICATE OCCUPANCY
Final
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