13405 SW BARNAM DRIVE hot
0
Ln
3 W Uj Er 121 It
C)
10
H
� ,, � �,
C) EJ) F4
H 0
C�
:V.
nr, 0
0
U)
LD
CD
:A-J BAPNAM ;M 1 0%
r
Address Permit No. _ P!53
Permit charge `' �._.._.�.�
Owner Connection fee
�.., Pari by1
L
Type of building <f ..... Date connecttd
Service rata � yo10,�C.� Inspection fee �
All
Contractor Paid by ,� Date
Size of connection �j�'� Assessment _ Paid
LOCATION.,._ . _. 4z.rKt,�Y�
—ill—lidl 1011
�.C.AV TIp'3 F xIL��.�._......,_.w,..�._.. I
HILL'14TION !
1
1
City of Tigard
INSPECTION REGUEST
for
I
INSPECTION T! ME : - 4/,*5L PERMIT
i DATE: 211717-3 DATE ISSUED:
OWNERS NAME .
ADDRESS
I CONTRACTOR KZ J Z
TEST'. Air [], Water C7 , Visual, Laboratory [)
RESULT: Approved,0 , Disapproved ❑ Pending []
I ;KETCH: +�
I /
12/q XK f
INSPECTOR DATE
COTE Alitoch supplemental test data heret]
1
UNIFIED SEWERAGE AGENCY NC. ___ 4853
WASHINGTON COUNTY DATE — 'Tune 13, 1973
CITY OF
APPLICATION FOR SEWER C i1NNECTION PERMIT
OWNER: --- C. B. Shirl!y — — --- - _ ---- ----
OWNER'S ADDRESS: I;. Hillvi" r_t�
STREET
siprd oregon _ 97223
CITY STATE 21P
BUILDING SITE: LOT—�_ -- BLOCK _ ADDITION .�E�Y1tNi0QC�I�llOI:_Barnum Park
TAX LOT NO. __ TYPE OF OCCUPANCY _- Residenne
ADDRESS ---�—
DWELLING UNITS__ _ __-__ FIXTURE UNITS _ ----- -
SURCHARGE IF APPLICABLE
PERMIT FEE _A5 INSPECTION FEE _25 .— TOTAL DEPOSITED __5_.______._
C(NEW) (EXISTING) BUILDING SEWER SYSTEM —___Tprd
—__ _
l he Applicant agrees to comply with all rules ,nd regulations of the Unified Sewerage Agency.
APPLICANT & 52f-4411"
---
010—
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
r
LINE SIZE -- 4"
RECEIVED BY--- - X' "Ale-OR ITS AGENT)
COMMENTS: _��. -�1E-�>>x - .� �° _ _ ► --
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.