13285 SW 107TH COURT r
S
" e
r�
r
7u PERMIT N0.
ADDRESS � �S —'
PERMIT CHAiiuE none
----Z �f-- CONNECTION FEE
OWNER y
PAID BY
------------- Zp
TYPE OF BUILDING /���
DATE CONNECTED do
_
INSPECTION FEE
SERVICE RATES --
CONTRACTOR ----
PAID B Y - DATE
ASSESSMEK( PAID -----
SIZE OF CONNECTION _—._-- ���/,�
.Z-
UNIFIED SEWERAGE AGENCY NO.
WASHINGTON COU N�-Y DATE
CITY OF Tigard -- ----
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: Clifton E. August - --
OWNER'S ADDRESS: 13285 SW 107th St.
STREET
---- --- -- --- STATE
CITY
BUILDING
OT -- BLOCK __-__—-- ADDITIONTax Map - -
residence
4101
TAX LOT NO. .- ----- TYPE OF OCCUPANCY
ADDRESS - 13-2,R5,- _-107th--S t.-- ------ _ - —
DWELLING UNITS-----------1 ----- - FIXTURE UNITS
SURCHARGE IF APPLICABLE-_ -- ----
PERMIT FEE _-- -
300_. - INSPECTION FEE . 25. TOTAL DEPOSITED 325.
- - - - --------
(NEW) (EXISTING) BUILDING SEWER SYSTEM Fanno Creek
The Apl,licant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
,�'
APPLICANT__1 L ---------
SEWER PERMIT
I
I
THIS PERMIT AUTHORIZES CONNECTION TO THE SE',"_-R SYSTEM. r
LINE SIZE _.------ - -----. ---- INSTALLER —_..
/
RECEIVEDBY
:_ _, d,? Pe— '`,'..
(AGENCY ITS AGENT(
I,
COMMENTS:1'er _U .,A,-order _�t70-12 premises existed prior to_ 1970__._-______
Sewer facilities become
This Application and permit expires in one hundred and twenty (120) days. III
The amount paid will be fol ieited should expiration occur. t