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for
INSPECTION TIME : m:�,O;w
PERMIT NO. '
.04-1E ISSL'ED:--/--L—
OWNERS NAME : _
AV,ORES
CONTRACTOR '——
TFST. Air 0, Water 0 Visual U Lnboratory L-1
RESUL'T'. Approve Disapproved El , Pending
SKETCH:
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INSPECTOR DATE
�OTE Attach supplemental test data haret:01
SEWER PERMIT
Imo ' N . ��-
Unified Sewerage Agency
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of wisftington County CITY OF DATE �� P���
Owr;FR : � � Gil/ ���X PHONE s�^� G
OWNER ' S A:pRESSs �•5 CUs C11��� �. O SLli Qcv+cc` )
TYPE OF INSTALLATION:
10 PUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY :
❑ NEW ❑ SINGLE FAMILY [] COMMERCIAL
�] EXIST. (PRIOR TO 7- 1-70 ) [3 MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS
ADDRESS OF STRUCTURE :
PERMIT CONDITIONS : THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CABLING FOR INSPECTION.
PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION EXPIRES IN ONE—
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIPATION OCCUR .
FEES: 00
PERMIT FEE $
CONNECTION CHARGE
SIDE SEWER INSTALLATION _
ISSUED BY
OTHER
TOTAL
APPLICANT DATE
SEINER PERMIT
0
ADDRESS OF STRUCTURE ,_/ S -T � J 5 U— lL� U-
TAX MAF' �� � — .�,<.'_ TAX LOT O G7 SYSTEM
LOT BLOCK OF
fS►�P0VED 8Y DATE I UED BYDATE
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D. U. _ REMARKS ' �J 1�—