12215 SW TIPPITT PLACE 12215 SW TIPPE`IT F,-ACE
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Address Permit No,
----- Y .�w--.�- E'ermit charge 677
Owner � _ ronnee`.ion fee
Paid by
Type of wilding ,tom_; _ Da Le connected
Service rate � ' T-opection fee
Contractor - Paid by bate
Size of connection Assevsment laid
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U4 SEWER PERMIT M1 13840
Unified Sewerage Agency
ofWashingtonCounty CITY OF Tigard — _ DATE Nov. 7_ 1977
OWNER : John A. Loewar - —_ PHONE : 639- 6,447
OWNER 'S ADDRESS: 12238 S `Clydesdale Court . i.inard.0eego�
TYPE OF INSTALLATION:
❑BUIL.DING SEWEF. ❑BUILDING SEWER AND SIDE SEWE=R
1 YPE OF OCCUPANCl r
j.IEW ❑x SINGLE FAMILY ❑ COMMERC I AL
❑EXIST . (PRIOR TO 7-- 1-70 ) ❑ MULT . RLS . ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITE, 1
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPE.Y WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION
EXPIRES IN ONE- E,UNDRED AND TWENTY ( 1L:0 ) DAYS . THE AMOUNT PAID WILL.
BE r=ORFEITED SHOULD EXPIRATION OCCUR .
FEESr
PERMIT FEE $ 600. 00
CONNECTION CHARGE r
SIDE SEWER INSTALLATION
ISSUED BY
OTHER Insp. Fee 25. 00
TOTAL $ 625. 00
APPLICANT DATE
OF T!F
4 P. E, SEWl is SERVICE,
BEGIN FGR THISSEWER PERMIT
M13840
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ADDRESS OF STRUCTURE 1221E SW Tippett P1. -
TAX MAP 2S1-30C — TAX LOT 5500 SYSTEM
LO-1 5 RL.0CK OF )
APRRUVED BY DATE ISSUED BY DATE
R[MARKS— _ Paidts I aro[—i Hsi nhi:� _,, ;yII�[In —,-
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