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9910 SW MCDONALD STREET
T.':-A.w r 9910 SW MCDONALD S'T'REET b ro C U Q U O r-4 aN m 1 SEWER PERMIT UUnified Sewerage Agency of Washington County C:TY OF DATE' �f! OWNER: RrfAm )tOf��l 4r 6K f HONE,_ (9 Y2 �/ OWNcR 'S ADDRE55: v Sri z o 44104,OL TYPE OF INSTALLATION, Q'70db SIDE SEWER [] LINE TAP AND SIDE SEWER U LINE TAP TYPE OF OCCUPANCY: ❑ NEW ❑ EXISTING SINGLE FAMILY ❑ COMMERCIAL EXIST. (PRIOR TO 7-1-71) ) ❑ MULT. RES. [j INDUSTRIAL FIXTURE UNITS DWELLING UNITS e ADDRESS OF STRUCTURE , q ( 7 1, 4"bo1hUJ[c + 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 forfeltad should expiration occur. The Agency does not guarantee the accuracy of the location of side sewer lalr If the sewer is not located at the measurement given, the Installer shall prospect three teat In all directions from the distance and depth given. if not so located, the Installer shall purchase a 'Tup and Side Sewer' Permit at the current charge and the Agency will Install a lateral at the location specified by the Installer. f F_E ES, s� P RMIT FEE s_ l✓.� 30 777"' � p© CONNECTION CHARGE LINE TAP INSTALLATION �— _._. ISAUD 8Y OTHER TOTAL 'J�✓�_ APPLICANT DATE SEXIER PERMIT AD',RESS OF STRUCTURE ggly 9(o �/�s�oh� � 9f I AX MAP S_ t t IA _ TAX LOT 7 UD `��1°q� SYSTEM LOT BLOCK /� OF —1&2k APPROVED BY DATE (� ISSUED BY DATE D. U. 'S ___._ REfdARK5g11W-- rG IM� L4in/lrQidr& (30k& ,