13425 SW BARNAM DRIVE r
e
✓1
m ,
I �
J H
,low
� Ow
Hn y I I 7
ct
1 ,
VA O
tj
M
MCZ4 �
u y
1
in
X
H
H
O �
IC17
cep n
'7I U
I
u '
y
13425 SW BARNUM DRIVE
2ATHO Wf1P123 e MS
n
z }.,
CD y
I--
Q
rn
CL
0-4J
a
t:7
u Q
Ir E-4 tr
Q
r n
u3 I
:1.
O
Qi H
s I
r 04 S I
i
1
,.r r
�.d
1�
1 L
C
r"[ C
i
W w p ( ra c rf)
x4P4
WWy
n to u, P, c�
1 -
� a 1
3n
OkJ U
y� N
Vl 1 I 1
7
E a r r r.3 t= 2 r
fn
ri -
v
r '
City of Tigard
INSPECTION REQUEST
for
INSPECT TIME :_ i�.�_ PERMIT NO. :LL-
DATE: DATE ISSUED:__1L.
I OWNERS NAME : -
ADDRESS :
AME : .ADDRESS :
r x Sr / fGL
CONTRACTOR
TEST. Air ❑, Water [3 , Visuallb;w Laboratory ❑
RESULT: Approved , Disapproved ❑ , Pending Lj
SKETCH: ---
I
I � �
i
S �
INSPECTOR DATE
COTE : Attach supplemental test date hereto
I
Address , � bxs r l Permit No.
1-�-�-�— Permit charge
Owner -- + i T Connection fee
Paid by
Type of building � - -�
Oats connected
Service rate Inspection few ;ISJ
datc4
%5LII `7 ._
/ice-
UNIFIED
iccUNIFIED SEWERAGE AGENCY NO. 4952
WASHINGTON COUNTY DATE March 1E, 1974
_
CITY Of TIGARD, OREGON 97223
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: __ ___0 D I N D. LEWIS
OUVNLR'S ADDRESS _ __Lot '4, Barnum Park, Tigard, Oregon_ 97223
STREET
STATE-_-`- 21P
BUILDING SITE: LOT -;14 —__ BLOCK _� ADDITION
TAX LOT NO. TYPE OF OCCUPANCY Resi.dence
ADDRESS ___—_ Sane as above.
DWELLING UNITS _-__..__- FIXTURE UNITS
SURCHARGE IF APPLICABLE —___— _
PERMIT FEE -.. 5ll0..S)O__ INSPECTION FEE __L25,O.OTOTAL DEPOSITED _ fwF2::. On
(N.E.1 I (EXISTING) BUILDING SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT
SEWER P`RMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE _.�O _- �_— INSTALLER --- --.___--- ---- --.._._--- ...___--
RECEIVED - �'t--��--+�
IA NCY OR ItS AOENtI
---- ---
COMMENTS:_—__
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
L
i
UNIFIED SEWERAGE AGENCY NO. ___-_ 4901
WASHINGTON COUNTY DATE - -- -�a-e-z�---------__
C I T Y O F -—__-- Tigard
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER. ____- Mr. Rhillip_Saxtan, Jr.
OWNER'S ADDRESS: 14130 S.W. 105
STREET
-
71P
BUILDING SITE: LUT4BLOCK ____ _ ADDITION ffornkm Park
TAX LOT NO. __ _-. TYPE OF OCCUPANCY
ADDRESS
DWELLING UNITS ... . 1_ __ - FIXTURE UNITS -
SURCHARGE IF APPLICABLE
PERMIT FEE ___-A50 INSPECTION FEE 25 TOTAL DEPOSITED 475
�(N�/ (EXISTING) BUILDING SEWER SYSTEM _ _ Tigard
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT.__,--_
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM,
LINE SIZE INST
RECEIVED BY_._-.___-.
I ITS ENT)
i
COMMENTS: __ 46641t'4J ,(k4, e _ ��>�,�L, C ,
J y
yy V
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.