11630 SW 79TH AVENUE MI' L Ir O 1
11630 SW '19TH AVENUE
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Receipt #
SEWER PERMIT M %11?6z
Unified Sewerage Agency
of Washington County CITY OF Tigard _ DATE. _____.2L19/79
OWNER: Bertna C. Mulford PHONE : 639-1561.
OWNFR' ' S ADDRESS
TYPE. OF INSTALLATION:
BUILDING SEWER ❑ BUILDING SEWER AND SI` SEWER,
TYPE OF OCCUPANCY: /
❑ NEW k] SI GLE FAMILY J COMMERCIAL
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EXIST. (PRIOR TO 7- 1-70 ) D MUL RES. [] INDUSTRIAL
FIXTURE UNIS _ WELLING UTS 1
ADDRESS OF STRUCTURE : 1 630 SW 79t
PERMIT CONDITI S: [HE APPLI ANT AGREES COMPLY WITH ALL RU ES AND
REGULATIONS O THE UNIFIED SEW RAGF AGENC . WHEN CALLING FOR NSPECTION,
PLEASE REFER TO THE PERMIT NUM ER. THIS APPLICAFIUN EXPE,S I ONE-
HUNDRED AND/TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE POR - 7 D SHOULD
EXPIRA.TIONy CCUR.
FEESe
PERMIT FEE �_-25, ❑❑
CONNECTION C RGE _ 600. 00
SIDE SEWER IN TALLATION ennv Ljgbertz __
ISSUED BY
OTHER ► ��•---I��—
TOTAL 705. 00 -%
a " l ti• , _ 9/1179
.3 6 l irk API!�L I CA T GATE
AC ..`E G ,
111, SLVI ER SERVICE
CHPRGWIL
E L OEGIR FOR Tk13
PJAMIT. SEWER PERMIT
N° 9f,961
ADDRESS OF STRUCTURE 11630 SW 79th
TAX MAP 151-36CD 'FAX LOT 2300 SYSTEM _ Fanno ri , ;..
LOT BLOCK OF
DWk 9/19/79 _ g �?1
APPROVED BY DATE I UED BY DATE
D. U. 'S 1 REMARKS Septic tank to be pumaed �DSL_�11L11_�,itb _
sand per State Code.