11492 SW 115TH AVENUE 11492 SW 1;5TH AVENUE
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ADDRESS Tti PERMIT NO. y
PERMIT CHARGE _ none
OWNER .,.�1,�, , r � ?,� z. r CONNECTION FEE
PAID BY > r
TYPE OF BUILDING / ,� DATE CONNECTED
SERVICE RATE INSPECTION FEE ,1 S
CONTRACTOR PAID BY DATE
SIZE 'IF CONNECTION ASSESSMENT PAID
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SEWER PERMIT
i'+T . 13849
Unified Sewerape Agency
of Washington County C I T Y OF Zj,.gr�l �� DATE: X0_77
OWNER . yoD or§ettie PHONE
OWNER 'S ADDRESS: 11 PD BoX 531'x.OjSI.uCI..Hglll _,__IIT 9oD 97 L___ _
TYPE OF INSTALLATION:
®BUILDING SEWER []BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
®NEW Q SINGLE: FAMIl_.Y CJ COMMERC.1 AL.
❑EXIST . (PPIUR lO 7-- 1-- 70 ) 0 MUL.T. kl- . 114DLJSTIRJAL
FIXTURE UNITSDWELLING 11NITS ._____.j _..
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR
INSPECTION, PLEASE REFER 70 THE PERMI"F NUMBER. THIS APPLICATION
EXPIRES IN ONE—HUNDRED AND TWENTY ( 12.0 ) DAYS. THE AMOUNT PAID WII_1-
BE FORFEITED SHOOLD EXPIRATION OCCUR .
FEES:
PERMIT FEE $_ 25.,00
CONNECTION CHARGE
SIDE SEWER INSTALLATION . _____ � W]._19011
ISSUED BY
OTHER
TOTAL
ii—in—117
` APPL. 1 C ANT DATE
FInTiCT PAYS Ir rR
' IVF aal l.. si,►�!�� �i.P- WE
WILL BEGIN SEWER PERMITM 13849
FEVN IT.
ADDRESS OF STRUCTURE_ 11492 SI,1 11;iLL,__LLI� s;Tj.,-_.lrAgC1J� --
TAX MAP TAX LOT SYSTEM _._ F a n n o Isju k_
L O T BLOCK r OF -
FTLI _ 11-10-77 _ �_ 11-10—. 77
APPROVED BY DATE ISSUED BY DATE
REMARKS