12205 SW SUMMER CREST DRIVE 12205 S ; SUMMER CREST DRIVE
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R :ceipt #5624
SEWER PEP''IIT Ni? 21 t91
Uf �
unified Sewerage Agency Tioard DATE: 3G 80
of Washington County CITY OF �
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OWNER : — Harol "Busch 'HONE :- 63�1 1767
OWNER 'S ADDRESS: _ 122115 SW S,.;n,mercrest Drive
TYPE OF: INSTALI_ATTU ! : I
❑ BUILDING SEW'-R h! BUILDING SEWER AND SID SEWER
TYPE OF OCCUPANCY:
[] NEW ❑ SINGLE F411LY ❑ COMMERCIAL
EXIST. (PRIOR TO 7- ' -70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTUR;- Ui,ITS DWELLING UNIT'S 1
A0ilRESS OF STRUCTURE : ._.._lZZDS -SW mm.rc est. Zrive - _
PERMIT CONDITIONSt TF-'E APPLICANT AGREES Tn (, .ii�1P1_Y WITH ALL RULES AND
REGULATIONS OF THE: UN':FIED SEWERAGE AGENCY . WHEN CALLING FOR INSPECTION ,
PLEASE REFER TO T11F, PERMIT NUi"L,ER . THIS APPLICATION EXPIRES IN ONE--
HUNDRED AND rWENT ! ( 1 ,o ) DAYS. THE .AMOUNT PAID WILL BF FORFEITED SHOULD
EXPIRAi Tui! OCCUR .
FEES:
PERMIT FEE $ 25, 00
CONNECIION CHARGE 300. 00
SIDE SEWER INSTALLAT'ON __ penny L1_3bert4, —
ISSUED BY
OTHER --
COTAL 315. 00
-
APPLICANT DATE
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CATP"�'CS� PLf 1f t
r� kyr E,
CRS',"LSE 1I:1LL eLGi l FOR TN1:; SE1���ER PERM I 1 N?
pet.;11T.
ADDRESS OF STRUCTURE ._ 12205 :.0 ;ummercrest Drive
TAX MAP 1.S1-34C8 TAX l_0T 20 20 _ SYSTE"i Fannu Creek
LOT 15 CLOCK � OF _ r jmmerhilla__
_
DW 1-1 4 X30 80 pi —..__.._ 4/30/80
APPROVED BY DATE ISSUED BY DATE
D. U . ' S 1 REMARKS jjTp & fill exiFtiny septic tank per State Code.
ALSO: LERON HEIGHTS SEWER SUhCHARGE OF $150.00 ��
Unified Sewerage Agency C3
of Yiashington County CITY OF _ Lra---- DA AT E '~; --
0 W P\l ER ; __ ��- -- — ---- — P H 0 N E :Z',L—�
OW�JER ' S ADDRESS : ------
TYPE OF INSTALLATION :
Ix BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
T`•'?'E OF OCCUPANCY :
❑ NEW SINGLE FAMILY ❑ COMMERCIAL
5EXIST. (PRIOR TO 7- 1-70 ) ❑ MULT. RES. ❑ INDUSFRIAL
FIXTURE UNITS _ DWELLIN5 UNITS -�_
ADDRESS OF STRUCTURE : S6_
PERMIT- CONDITIONS , THE APPLICANT AGREES 10 COMPLY 'vITH ALL RULES AND
REGULATIJNS OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR INSPECTION ,
°LEASE REFER TO THE PERIPIT NUMBER . 1HIS APPLICATION EXPIRES IN ONE-
HUNDRED AND T'WENlY ( 120 ) DAYS. THE AMOUNT PAID WILL. BE: FORFEITED SHOULD
EXPIRATION OCCljP .
FEES :
PERMIT FEE $ 2Sr
CONfJECTION CHARGE 3d D
SIDE SEWER INSTALLATION
ISSUED BY
O
TOTAL $
APPLICANT DATE - �—
ADDRESS OF STRUCTURE C-1�1- � 1V
'TAX MAP _ /S � ' � �� TAX LU-f .-Y�ZO O F-?thH u
Ic
LOT LS _BLOCK OF
.� .AFPRO D 6Y DAT-E ISSUED BY -�--------- DA1L - --
D . U . ' S ___ REMARKS ry - .. ��I _. �5 4- __Per ? C nose-