11338 SW TIGARD STREET 11338 SW TIGARD STREET
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UNIFIED &-BERAGE AGLNCY NO --WASHINGTON COUNTY COUN-1 Y DA FE _.---- 2-74-77-
CII-Y OF—Tir;ard
APPLICATION FOR SEWER CONNFCTION PERMIT
OWNEP _-- E.C. Jensen
OWNFR'S ADDRFSS: .____113-38 -S L-Tjg-ar
ST R E E T- -- -----
CITY STATE -
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Tax �7ap BLOCK .--- __-----_ ADDITION _ __- ---
TAX LOT NO. _1700_________ TYPE OF OCCUPANCY residence
ADDRESS .- 11338 SW Tigard St.
DWELLING UNITS_____ __ l FIXTURE UNITS {{
- i
SURCHARGE IF APPLICABLE
PERMIT FEE . _-25_.___ . INSPECTION FEE
25. _ TOTAL DEPOSITED _ 50.
(NEW) (EXISTING) BUILDING SEWER SYSTEM +_Fanno Creek
The Applicant agrees to comply with all rules and regut&i'Fns o the Unified Sewerage Agency.
APPLICANT- '• _� _... -__._._____^_._`��:;��._,•
SEWER PERMIT
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THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM. '
LINE S17F INSTALLER
RECEIVED BY.. -- -fc{ -;.tom. 174-
Paid to Lei on Heights X150.(AGENCY OR IT AGEh'i1
00 r
COMMENTS: ref._T-__ o. Permit # 11604 for informlition, overcharge of _:275. 00
applied to this permit. Residence was Cxistiog prior to 1970.. . . No bldg.
Permit issued at this time.
This Application and permit expires in one hundred and twenty (124) days.
The amount paid will be forfeited should expiration occur,