9895 SW GARRETT STREET 9895 SW GARRET`I' STREET
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C!FWER PERMIT N '.' 2x414 4
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W Unified S-*warage Agency jam'of Washington CountY CITY OF= �-�� � _ DATE2OZ2111rl
OWNER: t,L��.L�c=cam .:. _ PHONE
OWNER 'S ADDRESS r
TYPE OF INSTALLATIONr
C] SIDE SEWER ❑ LINE TAP AND S )iDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCY t
NEW ❑ EXISTING 1f1SINGLE FAMILY ❑ COMMERCIAL
EXIST. (PRIOR 10 7-1--701 ❑ MULT . RES. ElINDUSTRIAL
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FIXTURE UNITS DWELLING UNITS
ADDRESS OF STRUCTURE r ' zor
Permit Conditions: The appAcant agrees to comply with all lea and regulatiocs of the Uniflod Sewerage Agency,
When calling for Inspection. please refer to the Permit Number. The Application expires In ons hundred twenty (170)
dnys. T ! amount paid will be forfe;ted shoul•} expM1ration occur.
The Agency does not gu.:rantee the accuracy of the location of side sewer laterals. if the sewer In not located at
the measurement given. the Installer shall prospect three feet in all directions from the distanre and depth given.
If not so located. the Installer shall purchase a 'Tap and Side Sewer' Permit at the current charge and the Agency
will Install a lateral at the location specified by the Installer.
FEESr
PEfiMIT FEE
CONNECTION CHARGE
LINE TAP INSTALLATION
ISSUED BY
OTHER
TOTAL- s < J
EWER PERMIT N! 26414
^']DRESS OF STRUCTURE -Z , C.�'
TAX MAP TAX LOT _ -63 Z SYSTEM
LOT BLOCK _ OF
APPROVED BY ATE ISSUED BY DATE
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O . U. ' S REroARKS � `:�terL�
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