12305 SW SUMMER STREET ]; sil5 S4J "�Uf�iM13R :-,`1'lll'���1'
1
1
.�
QI
H
V�
N
�n
;;
v�
d
c*i
N
INSPECTION NOTICE
City of Tigaid Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639 4171
I--,'
1 1pe of Inspection - __ i�A
_/ �lS
Date Requested Z—S' Tine-- A.M.---P.M.
Address 1_0 - -11111 #_
Owner Lot
Builder
The following Building Code deficiencies are required to be corrected:
------yam---�-C.d�f��..c'b,,__.-�'�L�_ -- �a/� --
Prionted to
pp"Id
Inspector Disapproved
CALL FOR REINSPECTION
❑ YES 0 NO
SEWER PEF3PAff
Unified ber.crage Agency DATE
of Washington(.runty CITY OF — --- — -- —
PHONE
OWNi R 'S ADDRESS: 1XS06_
TYPE OF INSTALLATION: °
(SIDE SEWER ❑ LINE TAP AND SIDE SEWER L� LINE TAP
TAPE OF OULLj r";NCv,
❑ t+EW ('�CI1�c SINGLE FAMILY ❑ COMMERCIAL
EXIST. (PRIOR TO 7-1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
n �
FIXTURE UNITS _ DIE!LIf�iG UNITS.�! _
ADDRESS OF STRIICTUR'` : �"�'�4L'- -- —---- �-
,'ennit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,
When calling for Innpec:tion, please refer to the Permit Number. The Application expires in one hundred twenty (1n- )
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 faet In all directions from the distance and depth given.
If not so Ionated, the In-taller snarl purchase a 'Tap and Side Sewer' Permit at :ne current charge and the Agency
will Install a lalerc at the location specified by the Installer.
' FEES:
PERMIT FEE
CONNECTION CHARGE 410
LINE TAP INSTALLATION --
ISSUED E.Y
Cli HER
TOTAL-
APPLICANT -- DATE --
SEVER PERMIT
ADDRESS Of= STRUCTURE (2-30,3- cP)t0t)% 3��'-�C- ��--_
TAX ?-AP _j5I `"Z G _ TAX LOT ��04---_ SYSTEM
LOT _ _BLOCK _-- OF ---.- _-----
APPROVE; BY DATE ISSU
E
D BY DATE
D.U. ' S _.� �-._ -. REMARKS ��M�K . 1' j _�+��5 S � �