11365 SW GREENBURG ROAD 11365 SW GREENBURG ROAD
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?sic rens Permit No.
Permit charge ------- C
9wner lir _ Connection fee
Paid by
Type of huildinq Date conlected
SaruicP rate _ Inspection fere
Contractor Paid by Date
Size Of connarti,)n ,3sessmei � paid
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PERMO NO.
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SEVER P'ER') t IT M 13823
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Unified Sewerage Agency
of Washington County CITY OF, Tigard DATE 10-1.2-77
OWNER Jamns J. Rogers PHONE : 639-5743 _
OWNER'S ADDRESS:
TYPE OF INSTALLATION :
XPIMUILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
XXRMEW X® SINGLE FAMILY 1:3 Cr VMERCIAL
❑EXIST . (PRIOR TO 7- 1-70 ) MULT . RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1 r
PERMIT CONDITIONS: THE- APPLICANT AGREES TO COMPLY WITH AIA_ RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALi..ING FOR
INSPECTION, PLEASF REFER TO THE PERMIT NUMBER. THIS APPLICATION
EXPIRES IN ONE-HUNDRED AND TWENTY ( 120 ) DAYS . THE AMOUNT PAID WILL
Bt= f=ORFEITED SHOULD EXPIRA` loll OCCUR.
BEES:
PERMIT FEE y 25.
CONNECTION CHARGE 600• -
SIDE- SEWER INSTALLATION
ISSUED BY
0 T H F R
TOTAL_ s_ 625.
_- APDLICAwr DATE
N�' 13828
ADDRESS OF STRUCTURE 11365 SW GreenbuU_Rd. _ —
TAX MAP 151 35CA _ TAX LOT 1000 .- SYSTEM fanno creek
LOT . BLOCK __— OF
-- APPROVED Y DATE-~N! I SSKJFD BY DATE
Rl MARKS __ ---