11765 SW ANN STREET 3tj
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11765 SW ANN STREET
Address i 76Permit Plo.
Permit charge 22p72 �
Owner � .� � ronnec; ion fee lr- Ov
Paid by
Type oe buildi.no � 2Gate connected
Service rate Inspection fee _�2
--
Contractor _ Paid by date
,: ize of connection A33essment
Paid
City of Tigard
INSPECTION REQUEST
f o r
lNt, PFrTION TIML PERMIT NO.
DATE DATE ISSUED .—I—L-_
OWNFRS NAME '
i)N ' R ALTO R
v 0Tl+--e-0
F S? : Air [j, Wat"r C] 061101 j
;0t I * ApProved ni5approved r.. Pending
SKETCH
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1-10-W
2--3
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INSP T4R DATE
FNoTF Attach supr,*m%ente)l t*91 data berof
SEWER PERMIT ': 1388
L litilhi
ewt, eA ens CITY OF TIGARD
n y C1TY Of p_p_gQ233 '`aaTdA_�____ DATE _1�27-'lB
12420 S.W. Main
OWNER : _i Mr & Mrs ELC_jL- 9wjkLQpWr.Q 223 � PHONE :
OWNER ' S ADDRESS:
TYPE OF INSTALLATION :
XX[DBUILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
X®NEW x®XSINGLE FAMILY ❑ COMMERCIAL
❑E.XIST . (PRIOR TO 7- 1 - 70 ) ❑ MUL.T . RES. ❑ INDUSTRIAL.
FIXTURE UNITS DWELLING UNITS —
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALI. 114G FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION
EXPIRES IN ONE-HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WIL-L
BE FORFEITED SHOULD EXPIRATION OCCUR.
FEES:
PERMIT FEE $ 25.
CONNECTION CHARGE 600.
SIDE SEWER INSTALLATION
_ ISSUED BY
OTHER
TOTAL, /? .$_-
Ai:'PL-I CANT DATE
14G i l>:E: DAYS 4F T 'E
ABOVE DATE. SEWER SEAVICE ��/ p/�
CHARGE WILL BEGIN MR THIS SEWER PERMIT
i�U 13888P AIT.
ADDRESS OF STRUCTURE 11765 SL. Ann St.
TAX MAP TAX LOT SYSTEM Fanno creek
LOT BLOCK OF
APPROVED BY f>Alf ISSUED BY DATE
REMARKS no bldg. permit Paid to Leran Heights $150. 00