11585 SW 98TH AVENUE -- 1.1585 S'al 98TH AVENUE
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: i PERMIT NO.
DATE: ATE ISSUED I
OWNERS NAME :
A D D R E S S:
CONTRACTOR :
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UNIFIED SEWERAGE AGENCY NO. _5081 _
UUASH I NGT ON COUNTY DATE __ 4-29-75
CITY OF
APPLICATION FOR SEWER CONNECTION PERMIT
Alden Lewis
OWN E R: ---- -- - —
OWNER'S ADDRESS: __-_--_11565 S.W. 38th Ave. _
STREET
Tigard Oregon 97223
_ -----T.--- ---- ---- ala
BUILDING SITE: LOT-____________._ BLOCK ADDI1-ION
TAX LOT N0. ----- --- TYPE OF OCCUPANCY residence___a.�
ADDRESS __11585___S.W.,_98th Ave.
DWELLING UNITS ?. - -- ---__ FIXTURE UNITS -_------- --
SURCHARGE IF APPLICABLE - ------ --
PERMIT FEE . -- 57.5 INSPECTION FEE 25 .---- TOTAL DEPOSITED __..__.5511_
(NEW) (EXISTING) BUILDING SEWER SYSTEM
FannogCreek�_
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANY __.
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM. i
LINE SIZE _ __ __ 4 ' owner _..
_ INSTALLER —_ --___
RECEIVED BY-r- L-,1 afie±
(AGENCY OR GENT
COMMENTS:
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
FA
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ADDRESS---L/:> PERMIIT
ADDRESS
PERMIT CHARGE �__.
_none _..____v-----
CONNECTION FEE .�.-1--------'—"
OWNER ____-------
PAID RY --
-- � ALO _ DATE CONNECTED
TYPE OF BUILDING INSPECTION FEE ^'
SERVICE RATE Z --
C O N T F,A C T O R E^,C. ., u_�._.,___---=–
PAID BY c DATE
�) A S S E S S M E:NT PAID_.P
SIZE OF CONNECTION ---------