12435 SW KNOLL DRIVE-1 12435 SW KNOLL CRIVE
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SEWER PERMIT N9 =� 9
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Unrfi-9d Sewerage Agency
9 .�
of Washington unty CITY OF DATE
OWNER: GL PK0NE :
OWNER 'S ADDRESS- /
TYPE OF INSTALLATJON:
SIDE SEWER [' !INE TAP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
[] NEW V EXISTING SINGLE: FAMILY 0 COMMF:RCIA'.
EXIST. (PP'rOR TO 7- 1-70 ) MOLT . RES. r INDUSTRIAL
FIXTURE UNiTS,��_ DWELLING UNITS_
ADDRESS OF SIRUCTURE : ]
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
When calling for Irspectlon, please refer to the Permit Number. The Application expires In o:ie hundred twenty (120)
days. The amount paid will be forfeited should expiration occur.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer Is not located at
the measuremie+it given, the installer shall p•ospect three feet in all directions from the distance and depth given.
If not so located, the Installer shall purchase c 'Tap and Side Sewer' Permit at the :•u,rent charge and th(: Agency
will Install d lateral at the locations)scified by ;he installer.
FEE-S:
PEr�MIT FEE
CONNECTION CHARGE G
LINE TAP INSTALLATIONc.t .
ISSUED BY
OTHER
rip
TOTAL
APPLICANT DO E
SEWER PERMIT N?
ADDRESS OF STRUCTURE
TAX MQP r �J- / TAX LoT _ f wd _ SYSTEM��
LOT WON" _BLOCK OF
APPROVED BY ATt ISSUEn BY DATE
r). U . ' S / REMARKS
17
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N� i 2 2 7 DATE 1`<2_j
PERMIT IS 131VEN TO
OF
TO CONNECT A d#
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
TH!S PERMIT MUST BE POSTED ON THE DrSCRIBEll eREMISES UNTIL CON-
NEC'TJON i.i MADE AND INSPECTION OF CONNECTAON HAS BEEN COM-
PI,F'rED.
PERMIT FEEID $......
X ............ GARD bA ITARY DISTR L.
CONNECT ON ECTED D APPROVED
#Q/ Superintendent