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SEWER PERMIT 33004
UUnified Sewerage A7OmY CITY OF Tigard DATE February 11, 1987
of Washingmn Co:en'Y
OWNER: _ HarryE_3chaffer _ _ PHONE: : _ 639•-3-30__
iWNER' S ADDRESS: 11245 SW 91st Ave. 97223
TYPE 0i INSTALL.AIION:
® BUILDING SEWIR ❑ LINE TAP AND BUILDING SEWER ❑ i_INE TAP
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TYPE OF OCCUPANCY:
❑ NEW EXISTING x® SINGLE FAMiLY ❑ COMMERCIAL
❑ MULT . RES. ❑ INDUSTRIAL
FIXTURE UNITS _ _ DWELLING UNITS 1
ADDRESS OF STRUC-URE : 11245 SW 91st Ave. 97223__
Permit Conditions: Tie applicant agrees to comply with all rules and regulatiuns 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 ( .,rmit
fee, connection charge, line tap fee and/or other charge) will be forfeited if the permit expires.
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 purchase a "Tap and Side Sewer"
Permit at the current charge and the Agency will install a lateral .
FEES:
PERMIT FEE s 35-00
CONNECTION CHARGE 97'-00
LINE TAP INSTALLATION
ISSUED BY
OTHER
TOTAL % 1,010.Uu `- DATE OF I SSUUl E
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-APPLICt'NT DATE OF� EXP ! RAT ION
aEWER PFRoMIT
PDDI,ESS OF STP.UCTURE _ 11245 SW 91st Ave. 97223
TAX MAP 1S1-35DBTAX LOT 100 QUARTER
--- - SECTION ---
LOT
-LOT BLOCK _ _ OF _
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RTW - ----Z._ii-S7 / /_
APPROVED BY GATE ISSUED B'. DATE OF ISSUANCE
J . U. ' S 1 REMARKS _ 411 P' a regd. Septic tank to-he pumped &_ filled_
Contractor to obtain street opening permit.
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INSPECTION NOT'CE
City of Tigard Building Department
P.O. Box 23351
Tigard, Oregon 972?-'
Phone: 63q-4175
Type of Inspection ---
Date Requested----.__._-- ' Time---- A.M.
/ /
Address .____ ,._— T-�ti Permit
Owner_�L2 - / �pVVV7 — Lot #__
Builder_ — — —_-- --The following Building Code deficiencies a : required to be corrected:
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Prasenti d to fE Z Approved
InsFector _ _ �.� Disapproved
Date
OR REINSPECTION
YES l l NO
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