9975 SW GARRETT STREET-1 •u.
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low
Address �a 9Z-�L Permit No.
Permit charges .,
ate'
Owner Connection fee X125-
s
_^ _^ Paid by
Type of building % �,( .,,� Date connected
Service rate �%y, Inspection fee 125'`'"
Contractor Paid by Date
Size of LUMIaLLiun _ Assessment paid
3 -9 77 J77 - mac
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME PRMIT NO. :
DATE ISSUED -
OWN E RS
SSUED ..OWNERS NAME ; �'!�
ADDRESS: ` q-Z.K
CONTRACTOR :
rE ST . Air 0, Woter i Visual-91 Laboratory ❑
RESULT: Apptoved.0 --frisapproved C Pending C7
SKETCH:
r
i a
INSPECTOR DATE
5OTF. Attach supplemental test data hereto]
r,0. 9599
lif-JIFIF- D SUVE- RA(" N" I'My
VY,ASIAINGTON COUNTY DATE J!I!:Z 27, 1976
C11'Y 01: --Vizard-
APPLICATION FOR SEWER CONNECTION PERMI r
OWNER: _ hes.t<ex. Curvy -- --- - - ___ - --------- _..— -- -_-
OWN E R'S
-------
OWNER'S ADD R ESS: .--q9j5
STREET r`
g,T Y STATE ZIP
BUILDING SITE: LOT-. BLOCKADDITION
Tax Map 2S1 2CB
TAX LOT NO. _3800.__. . TYPE OF OCCUPANCY __residence
ADDRESS .-..-.-.-9975 S14 Garrett ---
DWELLING UNITS------ .-... FIXTURE UNITS
SURCHARGE IF APPLICABLE
PERMIT FEE . ..575,00
INSPECTION FEE TOTAL DEPOSITED 600.00
(NEW) (E.XjSjJ-NfA— BUILDING SEWER SYSTEM Fanno Creek
The Applicant agrees to comply with all rules and regulations of the UnifiQd Sewerage Agency,
LA--,
APPLICANT ('.-�. ,(I
SEWER' PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
810 Owner
LINE SIZE INSTALLER
RE-CLIVED BY-
(AGENGY OR ITS A ENT)
COMMENTS:
This Application and permit expires in ninety (90) days. The amount paid will be f,)tfi,lied
should expiration occur.