10085 SW KATHERINE STREET mI
10085 SW KATHERINE STREET
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SEWER PERMIT
Unified Sewerage Agency
of Washington County CITY OF _ T10,66-4DATr O
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OWNER : _ H 5fV`0 PPON_ PHONE
OWNER 'S ADDRESS: 5 SU ICfCkM er1jie- 5��-•_ _
TYPE OF INSTALLATION:
SIDE SEWER [] LINE TAP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
❑ NEW ❑ EXISTING; W,SINGLE FAMILY ❑ COMMERCIAL
!?Q,EXIST. (PRIOR TO 7- 1. 70 ) ❑ VULT. RES. ❑ INDUSTRIAL
FIXTURE UNITSDWELLING UNITS.Olt
ADDRESS OF STRUCTURE : _
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,
When calling for inspecto,,n, please refer to the Permit Number, The Application expires in one hundred twenty (120)
days, The amount paid will be forfeited shoulo expira-tiun occur.
The Agency does not guarautP,e the accuracy of the location of side sewer laterals. If the sewer Is not located at
the measurement given, the Installer shall prospect three feel In all directions from the distance 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 th3 installer,
4F S:
PERMIT FEE �5�----
CONNECTION CHA:gGE 3DZ�
LINE TAP INSTALLATION _
OTHER W-
�~ ISSUED BY�+
TOTAL
APPLICANT DATF
SEINER PERMIT
ADDRESS OF STRUCTURE I00 8J 5 `e �
TAX MAP <� `� I - �, TAX LOT SYSTEM
LOT JILOCK OF
V E D E3 Y ATE
R" ISSUED BY DATE
0 - U . ' S _�r�_ REMARKSRif dwI_s� ' �G iq�r� rii- spiJe Ge
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4 I t N e. N: cM
CITY TIGARD DATEJIM"It'
BUILDING PERMIT APPLICATION of '7�19 - _
1HF UN[)EPSIGNED HEREBY APPLALS FOR APERMIT FOR THE WORK HEREIN INDICATED ®IJII_OERPHONE
r Ot/.NER?Hr�NE/_�_. 6
11 7.6
OR AS SHC'WN AND APPROVED IN THE ACCOMPANYING PLANS AND SIFCIf IC.-f1ONS LOTNO_��_�--- .•
OWNER 0A{ — J46 ADDf7E55�GG � =--- ARCHITECT
r� FNGINEER
EtUILOCt4 IV► OF'SIGNER _--_ — _-- --
CI
[-.J� nn E„AL L.JFIRE DAMAGE JCJG COLI I I.i
STRUCTURE LNEW ❑FTEM[l!'EL LJAOOITION LJ REPAIR � _. -----,_--- _- -.__..
nESIDENCC COMM ❑EDUCATIONAL CJr.OV T ORELIGIOL�SL7PATIO L..ICAR PORT IJGAR4GiE,CJTORR EOSLAB rEN^
ot fir�TvPFAW FIRE 7ONF-./ 11 AN CHECK BY HEAT
Ci�►e�`�v��t.� 7'-p^ r-e w f
SEWER PERMIT_
OCC LOAD FLUUCI , F .ICH Nn STORIIS AREA �.�� tlE�7pOSJti'S _.VA.._LQ. < .S •
-- BUILOIN-; D: rc. T PACKS I-HONT REAR I El•1 SIDE Y P .,,T SIDE _-
Pr:mtt
Fif '.1I'i !S ISSUEO SUBJECT TO 1HE REGULATIONS CONTAINED IN THE BUILDING CODE. LGNtN
Pian Check r '-'LAIICINS ViD Al L APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED 1HAT TI
,YI L f NE IN ACCORDANCE WITH fHE PLANS ANDSFECtFICATIONS AND IN CON%PLICN(.E V41T
U1.)tCttBl ,S.
f CODES AND ORDINANCES THE ISSUAMCE OF THIS PERMIT DOES NOT WAIk
FNANT5 CONTRACTOR AND 5118 rOE;TRACIORS TO HAVE CURRENT CITY 9U51NE
State Tax � I. IE PERMITS PEOUIRED FOR SEINER PLUMBING AND HEATING
�I.
Total c -
Byv APPLICANT OFG
AENT
�A DUI uvFl;
Atl NI Sk
SDC
PDC ___ ---- -—
5CWE R LT ION
SEWER INSPECTION
SFWER SIJRCHARGE
Comments: