10350 SW KABLE STREET-1 L0350 SW KABLE STREET
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INSW—TION NOTICE
City of Tigard Building Department
12420 S.W.Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspectier. ._.� --
Date Requested Time_ A.M.____P.M.
p Permit #
AdJress _ �__ _` c7 � --- -
I
Lot fk
Builder
The following Building Code deficiencies are required to lie corrected:
Presented to ❑ Approved
Inspector _ ❑ Disapproved
Date —
CALL FOR REINSPECTION
(=l YES ❑ NO
SEINER PERMIT N�� 271'77
u -
Unified Sewerage Agency
of Washington County CITY OF 6 Z DATE
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OWNER:
OWNER ' S , PHONEe r C.
S-cc� -en • ,
ADDRESS: ��j=(%� I
TYPE OF INSTALLATION:
❑ SIDE SEWER ❑ LINE 1AP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
❑ NEW ❑ EXISTING ❑ SINGLE FAMILY U COMMERCIAL
B,EXIST. (PRIOR TO 7- 1-70 ) ElMOLT. RES. ❑ INDUSTRIAL
FIXTURE UNITS_ DWt=LLING UNITS _
ADDRESS OF STRUCTURE : -
Permit Conditions The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
When calling for Inspection, please refer to the Permit Mumbur. The Appli(ation expires in one hundred twenty (120)
'lays. The amount paid will be forfeited should expiration recur.
The Agency does not guarantee the accuracy of the location of side sewer laterals. if the sewer is not located at
the measurement given, the installer shall prospect three feet 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 Incation specified by the Installer.
Fr ES:
PERMIT FEE
CONNECTION CHARGE
LINE TAP INSTALLATION —
ISSUED BY
OTHER
TOTAL s 1� ~ ✓t ��
- APPLICANT �- DATE
ABOVE: F SEW'.�. nbYSEWER PERMIT ,�
ABOVE pATE s�wFA stn � N . 27177
ADDRESS OF STRUCTURE /��_-�`'G' __.�.;<< C •� �J� r
TAX MAP _y TAX LOT SYSTEM
LOT _— —B L.O C K _ ___._ OF
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APPROVED BY DATE ISSUED BY Op�C
D. U. ' S _ REMARKS =!' �'C1 t _ ,� ,' �� -e �� 11d��C _"`