11820 SW TIEDEMAN AVENUE 11820 SW TIEDEMAN AVENUE
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INSPECTION NOTICE i
City of Tigard Building Department
12420 S.W.Main St.
Tigard Oreton 97223
Phone: 639-4171
Type (,I Inspection
Date Requested
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Address �ZU ((� ! I E' ---- Permit
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Owner- —^ --- Lot #.. -- ------
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Builder — - --- ---------- -- 1
The following Building Code deficiencies aro required to be corrected:
-46
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Pre ntA to _ _— Approved
(� !f
Ins ctor Ju-
Disapproved
Date � —.--
C REIN PECUM
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0 YES ❑ NO
r SEWER PERMIT
�f�� .Uni'ied Sewerage Agency
of Washington County CITY OF _ DA1
OWNER : �� `�b�J ` —_ PHONE :
OWNER 'S ADDRESS: •- -�--
TYPE OF INSTALLATION:
XSIDE SEWER ❑ LINE TAP AND SIDE SEWER ❑ LINE TAP
T; PE OF OCCUPN/CY:
❑ NEW 1 tx SINGLE FAMILY ❑ COMMERCIAL
EXIST. (PRIOR TO 7-1-70 ) ❑ MULT. I;ES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS QN
ADDRESS OF S-CRUCTURE : ,, ve,, —
Permit Conditions: The applicant agrees to comply with all rules and regu ations of the Unified Seworage Agency,
When calling for Inspection, please refer to the Permit Number. The Application expires in one hundred twenty (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
the measurement given, the installer shall prospect three feet in all directions from the distance and depth given.
If not so located, 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:
PEPMIT FEF
CONNECTION CHARGE
LINE TAP INSTALLATION
r ISSUED BY
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TOTAL � --- 3
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APPLICANT 1" �--�-�— DATF
SEWER PERMIT
ADDRESS OF STRUCTURE �� �il�;� 1 + �'Mt�✓Ikra' '
TAX MAP TAX LOT _ Jvv� _ SYSTEM _&4406�
LOT BLOCK OF
APPROVED BY DATE ISSUED E3'r DATE
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