12180 SW SUMMER CREST DRIVE 12180 SW SUMMER CREST DRIVE
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SEINER PERMIT
Unified Sewerage Agency �� DA FL '
(f Washington County CITY 0 F -——
PHONE: �4l�/'
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
SIDE SEWER ❑ LINE TAP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
❑ NEW [1 EXISTING KI. SINGLE FAM',LY FL-] COMMERCIAL
EXIST. (PRIOR TO 7-1-70 ❑ PULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS_' _-___�f___
ADDRESS OF STRUCTURE :
Permit Conditions: The appllcant agrees to comply with all rules and regulations of the Ur,1fied Sewerage Agency,
When calling for Inspectior, please refer to the Permit Number. The Applice.tion expires in one hundred twenty 020)
days. The amount paid will be forfeited shoul,' tixpiration occur.
The Agency does not guar:ntee the accuracy of the location of side sewer laterals. If tl:e sewer is not located at
the meas�rPmpn! given, the installer shall prospect three test in all directions from the dista-..e and depth given.
It not so located, .he 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:
P EPMIT FEE $- -- --
CONNECTTON CHARGE 3 O0 --
LINE TAP INSr^,L I_.AT'I0N � ISSUED BY
OTHER - -
t 0 T A L. -�-'�' -- -
APPLICANT DATE
SEVVE-P PERMIT
ADDRESS OF STRUCTURE
TAX MAP �c� � 13e _'_- G_ rnx I n r ����,— SYS-EM
LOT Z BLOCK .--r OF
APPROVED BY DA-TE ISSUED E3Y�.--� DATE �_�----
D . U . ' S ..____� — RENAR KS ~. d� �� SE;:ToTC• aN �' 9" !�.
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