15900 SW 76TH AVENUE 15900 SW 76TH AVENUE
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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection � c
Date Requested /• – 9– _�"' 11me___ A.M.—�-.5 P.M.
Address
Permit #_ _
Owner_ Lot #
Builder
The followinB ilding Code deficiencies are required to he corrected
Presented to _ ( pproved
Inspector _ _ Disapproved
Date
FOR REINSPECTION
C] YES ❑ NO
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SEWER PERMITS 27944
UfUnfied Sewpr,�ge Agency L-"I T'i OF < T �L- DATE
of N!eshingto ounty /-�
1 !NER : --- PHONE :
CWNER' S ADD ESS: s �:� N, i \ =----- --
'TYPE OF INSTALLATION:
BUILDING SEWER ❑ LINE TAI' AND BUILDING SEWER ❑ LINE TAP
TYPE OF OCCUPANCYt
❑ NFW rlvn EXISTING I-V SINGLE FAMILY ❑ COMMERCIALY-V f
❑ MULT . RES. ❑ INDUSTRIAL
FIXIURE- UNITS DWELLING UNITS
ADDRESS OF STRUCTURE t rAe) SZe��7(6 q_
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified
Sewerage Agency. When calling for an inspection, please refer to the Permit Number. The Permit
expires one hundred twenty (120) days from the date of issuance. The total amount paid (permit
fee, connection charge, lime tap fee and/or other charge) will be forfeited if the permit expires. i
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 given, if not so located, the installer shall pi!,chase a "Tap and Side Sewer"
Permit at tte current charge and the Agency will install a lateral.
FEESt {
PERMIT FEF
CONNECTION CHARGE
LINE TAP INSTALLATION _
— � ISSUEU BY
OTHER
TOTAL
APPLICANT DATE
3a r)AYSEROMTHE: :FSEWER PERMIT M' 27944
,.. CICE
°kCllito�,; TI;ISPERMIT
ADDRESS OF STRUCTURE ✓ f/'G �� �� `_ - --
QUARTER
TAX MAP TAX LOT _ SECTION - —
L 0 T BLOCK OF
h PROVED BYDATE U D BY / 0A1iF OF i55.1 CE_
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D . U. ' S REMARKS L^ ' � j�"�-- --
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