11805 SW GAARDE STREET 11805 SW GAARDE STREET
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_ Receipt4p-?frv�
SEXIER PERMIT N? 20170
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fied Sewerage Agency DATE 9�24�79
ot. Washington County CITY OF T.iga rd _
OWNER : Paul & Linda Anderson _ PHONE :_6.20-7742
OWNER ' S ADDRESS:
TYPE OF INSTALLATION:
2 BUILDING SEWER L] BUILDING SEWER APID SIDE SIWER
TYPE. OF OCCUPANCY:
❑ NEW ED SIV LE FAMILY COMMERCIAL.
❑ EXIST. (PRIOR TO 7- 1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS ._..__ DWELLING UNITS__ _
ADDRESS OF STRUCTURE : 1.1805 SW Gaarde Street
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SFWERAGF AGENCY. WHEN CALLING FOR INSPECTIO14 ,
PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE-
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILT_ BE FORFEITED SHOULD
EXPIRATION OCCUR .
FEES:
PERMIT FEE $_ ._25. 00
CONNECTION CHARGE fl_ n
SIDE SEWER INSTALLATION W _ _-- Penny Liebertz _
ISSUED BY
OTHER
'TOTAL.. $ 325. 00
9/24/79____
U DAYS OF THE APDL ICAN'L DATE
I�.Jt1'J'E GATE, SEW, ER SFRM, CLl P 33T
J4-00E ','1111 135-G14 F01 TV"
No
i t
AF)DRF_SS OF SIRUCTURf_= 11.805 SLI Gnarde Sl.rnot:
TAX MAP 2_ 15 3LD TAX l_nT 3701 SYSTEM _ F nno Creek—
LOT BLOCK OF Hazeltree
_ DWH 9/24/79 9/279
APPREIVED BY DA1 F ISS . f D EY DATE
D. U . ' S 1 RL-MARKS Septic tank to be pumpted and filled With sand,
as per state rode.