14465 SW 125TH AVENUE-1 r
SEWER PERMIT
` Unified Sewerage AgencyZ�Z
of Washington County CITY OF ---� �_`* DATr. '3'
OWNER : � ��� PHONE
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
IY2 SIDE SEWER ❑ LINE TAP AND SIDE SEWEF; ❑ LINE TAP
TYPE OF OCCUPANCY:
❑ NEW [1 EXISTING ® SINGLE FAMILY ❑ COMMERCIAL
[] EXIST. (PRIOR TO 7-- 1-70 ) ❑ MUL1 RES. ❑ INDUSTRIAI-
FIXTURE UNITS_ DWELLING UNITS
ADDRESS OF STRUCTURE : 06�O'V'Q—
Pern„!t Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,
When calling for inspection, please refer to the Permit Number. The Application expires in one hundred twenty (12tJ)
days. The amount paid will be forfeited should expiration occur.
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 and depth 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 at the location specified by the installer.
FEES:
PERMIT FEE r�Qi+-�r� •� s
CONNECTION CHARGE
LINE TAP INSTALLATION _
OTHER
ISSUED BY
TOTAL
APPLICANT DATE
SEWES.PPOT
ADDRESS OF STRUCTURE
TAX MAPS TAX LOTSYSTEP9
LOT .-_ BLOCS OF
AF'F'R[IVED E3Y DATE1 V PISS j � ` DATE
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D. U. ' S REPJARKS _ P pot.
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SEVVER PERMIT
Unified Sewerage Agency L��
of Washington County CITY OF _-�� -re"e DAT, 551- d- d��
OWNER: � PHONE • �� �
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
❑ SIDE SEWER ❑ LINE TAP AND SIDE SEWER ❑ LINE: TAP
TYPE OF OCCUPANCY:
❑ NEW ❑ EXISTING ❑ SINGLE FAMILY ❑ COMMERCIAL
0 EXIST. (PRIOR TO 7-1--70 ) ❑ MULT. RES. ❑ INDUSTRIAL-
.
FIXTURE UNITS_ DWELLING UNITS
ADDRESS OF STRUCTURE : _
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,
When calling for inspection, please refer to the Permit Number. The Application expires in one hundred twenty (120)
days. The amount paid will be forfeited should expiration occur.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer I:: not located at
'he measurement given, the installer shall prospect three feet in all directions from the distance and depth 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 at the location specified by the installer.
FEES:
PERMIT FEE �� �> •� a �,i __
CONNECTION CFARGE
LINE TAP INSTALLATION
OTHER
ISSUED By
TOTAL $
APPLICANT
DATE
SEMER ,PERMIT
P,DDRESS OF STRUCTURE
(AX MAP `jam TAX LOT SYSTEM
i-
_
I
LOT BLOCK OF
APPROVED BY DATE ISSUED BY DATE
D. U. S RFNARKS �:'�.... c' -" - �,, � _ �,•-
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