11000 SW NAEVE STREET 11.000 SW NAEVE STREET
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SEWER PERMIT 3 3 4 7 9
UUnified Sewerage Agency CITY OF Tigard DATE 6/15/87
of Washington County —OWNER : Peck !_ PHONE :
OWNER' S ADDRESS: 11000 S.W. Naeve Street
TYPE OF INSTALLATIC%:
❑ BUILDING SEWER ❑ LINE TAP AND BUILDING SEWER ❑ LINE TAP
TYPE OF OCCUPANCY,
i
❑ NEW EXISTING ❑ SINGLE FAMILY ❑ COMMERCIAL
❑ MULT . RES. ❑ INDUSTRIAL
FIXTURE UNITS J DWELLING UNITS 1_
ADDRESS OF STRUCTURE , -- 111 &0 -;
Permit Conditions: The applicant agrees to comply with all rules and regulat'.ons of the Unified
Sewerage Agency. When calling for an insp ,!—, please refer to the Permit Number. The Permit
expires one hundred twenty (120) days fro,. tt. ; .te of issuance. The total amount paid (pe unit
fee, connection charge, line tap fee and/or V .r charge) will be forfeited if the permit expires.
The Agency does not guarantee the accuracy :f the location of side sewer laterals. if the sewer
is not located at the measurement given, th, installer shall prospect three feet in all directions
from the distance 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,
FEES:
PERMIT FEF $ _ 35.00
CONNECTION CHARGE 975.00
LINE TAP INSTALLATION
IS ED BY
OTHER
TOTAL ¢ 1010.00 _ DATE OF I SSU (N�
10-13-87
APPLICANT DATE OF EXPIRATION
SEWER PERMIT
ADDRESS OF STRUCTURE aup StrcrPt-
TAX MAP 2S1 10DB TAX LOT 900 QUARTER 10
SECTION
LOT BLOCK OF
APP OVFD BY - ' DATE Y ISSUED BY ~� DA"iE OF ISSUANCE
D . U . ' S 1 REMARKS Min 4_ 'wipe required; seerl-ic tank must be pwiped y
and filledwith gravel - Ttv.per_tio'n