10240 SW KATHERINE STREET-1 1.0240 SW KATHERINE STREET
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Receipt #5665
SFWcR PERMITN 2 119 7
U01
Wo Unified Sewerage Agency
of Washington County CITY OF Tigard^ _ DATE 5/6/80
OWNrR : Otto Blum PHONE : 639-3229
OWNER ' S ADDRESS - 10240 SW Katherine Street
TYPE OF INSTALLATION:
CYC BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
❑ rJEw [kl STN SLE FAMILY ❑ COMMERCIAL
EX,IST. (PRIOR TO 7--1-70 ) ❑ MUi_T. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1
ADDRESS OF STRUCTURE : 10240 Sw Katherine Street
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIUN:, OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR INSPECTION ,
PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE-
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATTON OCCUR .
FEES:
PERM ;T FEE $ 25. 00
CONNF„TION CHARGE _ 00. 00
SIDE SEWER INSTALLATIOii Qnnny I iebertz _
ISSUED BY
OTHER
TOTA $ 325. 00
5/6/80
APPLICANI- DATE
NOTICE' d_OAYS OF %E
p�gtfE 0,11 t. SEVER SER'y'ict
BEGIN FOR THIS SEDER PERMIT
rcar�� N? 21 1 .97
ADDRESS OF STRUCTURE 10.240 SW Katherine Stropt
TAX MAP 2S1-•288 — TAX LOT —__FJOO SYSTEh+ Fanno Creek
L01 BLOCK G
DWH,,. 5/6/80_ — al 5/6/90
A.PPRIVFD BY DATE ISSUED EY �Y DANE
D . U . ' S _ 1 _ REMARKS _Demolish existing septic tank or gurr� end
Fill with sand per State Code.
Minimum 411 pipe required.
SEWER
(1.
�I )J� �.� ned Sewerage Agency
of Washington County CITY OFf�l ^ __ DATE
OWNER : _ PHONE
OWNER ' S AF!DRESS :
TYPE OF INSTALLATION :
BUILDING SEWER ❑ BUILDING SEVJER A,',lL SIDE SEWER
/TYPE OF OCCUPANCY:
❑ NEW SINGLE FAMILY ❑ COMMERCIAL
f
EXIST. (PRIOR 'TO 7- .-70 ) ❑ MUl_T. RES . ❑ INDUSTRIAL
FIXTURE UNITS_. -- DWELLING UNITS^ __
1
ADDRESS OF STRUCTURE : A boy --
PERMIT C')ND 'TIONS : THE APPLICANT AGREES T'0 COMPLY WITH ALL RULES AND
REGULATIONS Cc. THE UNIFIED SEWERAGE AGENCY. WHEN (,A! LING FOR INSPECTION,
PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION L-XPIRES IN ONE-
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION 07'7UR .
FEES :
PERMIT FEE
CONrIECTION C 4/+RGE _ '�►
SIDE SOWER [NST,'LL_ATION
- ISSUr:O BY
OTHER
TOTAL
�. APP I. I CANT DATE
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ADDRESS OF STr?!,'CTIJRE lI�J P*u e— N
TAX MAP ��� _- FAX LUT _ SYSTEM d
LOT" _SLOC K OF
4V -
APPROVED BY DAIk IS'SUCU BY DATE
D . U . ' SREMARKS -be 461�S�Q�� 1G�i�r���_l�Li���t1��Ar-