11640 SW TIEDEMAN AVENUE 11640 SW TlEDEMAN AVENUE
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INSPECTION NOTICE
City of Tig3rd Buildi,ig Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspectlen
Date Requested—AVUAM I P.M.
- i ime—-- A.M.
Address 9a) 014 e— Permit
Owner Lot
Builder
The folluwing Building Code deficiencips are required to be corrected:
Ao---
Presented to Approved
Insper- Disapprov-.d
Date
CALL FOR REINSPECTION
Yale ch No
J
i SEWER PERNUT
UU-� nified Sewerage Agency
of Washington County CITY OF _ , DATE E _p_
OWRIFR: - 4 Mz) R 12
a co _- _ PHONE :G{�U
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
❑ SIDE SEWER [, LINE TAP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCLIPANCY:
❑ NEW ❑ EXI51-ING SINGLE FAMILY (`] COMMERCIAL.
EXIST. (PRIOR TO 7- 1-70 ) ❑ MULT. RES. ❑ INDUSTRI.",L
FIXTURE UNITS_ DWELLING UNITS---
ADDRESS OF STRUCTURE s . Aytj 7-os- tip "o &ky _ ^�
Permit Conditions' The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,
When calling for Inspection, please refer to the Permit Number. The Application expires in one hiindred t%.!enty (120)
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
thy, measurrmant given, the Installer shall prospect thre9 feel In all directions from the distance and depth given.
If not so loci.'-d, the 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:
PERMIT FEE
CONNECTION CHARGE
LINE TAP INSTALLATION
OTHER ISSUED BY
'TOTAL
APPLICANT DATE s
SEVER PERMIT
ADDRESS OF STRUCTURE ir�0 J_ i_1 •Q _►Nn4 ,JZ_
TAX MAP ,��1 3 S C� _ TAX LOT � 4-y' 6C) SYSTEM , fie♦IPSO ,
LOT _ -__v._.-B L 0 C K --------- OF ---- — _
(gAt/- _Y F_ Ir-
APPROVED BY DATE ISSUED BY DATE ,✓ ,
D. U. ' S _ REMARKS __ f� �' 4V '�