9640 SW FREWING STREET-1 9640 SW FREWINC S`1'REM'
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DATE : __JZj %1-, DATE ISSUEn '__L Z
OWNERS NAME : _._____-rte
A D D R E S S:
CONTRACTOR '.
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SKETCH,
NSNj_ 'TOR DATE
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SEWER P'ERP.4i,T
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Unifiedr.ie A i ewera3 Agency
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of Wasngton County CITY OF � DATE
OWNER : PHONE : 3 9-
OWNER 'S ADDRESS : — ?�,/ y ?Gt% ----
TYPE OF INSTALLATION:
IxBUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPAfICY:
❑ NEW SINGLE- FAMILY ❑ COMMERCIAL
EX ICT. ( PRIOR TO 7- 1-70 ) � MULT. RES. ❑ INDUSTRIAL_
FIXTURE UNITS DWE!-.LING UNITS
ADDRESS OF STRUCTURE :
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATION, OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR INSPECTION ,
PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION EXPIRES IN ONE-
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR .
FEES:
PE=RMIT FEE $ �–
CONNECTION CHARGE
SIDE SEWER INSTALLATION �7t,
ISSUFD BY
ETHER
oc
TOTAL
APPLICANT T DATE
SEVER PERMIT
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LOT —BLGCK OF _
APrROVED BY
DATE ISSUED BY pgTE
D. U . ' S REMARKSst�c,s `Z,� -