12295 SW TIPPITT PLACE 12295 SW TIPPETT PLACE
i
ADDRESS J PERMIT NO.
PERMIT CHARGE none
CONNECTION FEE 45-
OWNER /e�,.-,�• �-c�.�- - --- —
PAID BY
TYPE OF BUILDING ,,2ey� w� f:�iE COV; [C TED
SERVICE RATE i INSPECTION FEE
CONTRAC TCR „ _ PAID BY _ DALE
SIZE OF CONNECTION A53F'SSMENT PAID
Y
17
UNIFIED SEWERAGE AGENCY NO. --__].1690 __----
WASHINGTON COUNTY DATE ._..W_3�1s-77 _
CITY OF. TiQa r d . - ------ --
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: da Gauss -- -
OWNER'S ADDRESS:
STREET
CITY STATE ZIP
BUILDING SI-L3,H 1.OT.. .. BLOCK __ _ ADDITION
Tax Map 251 6000
TAX LOT NO. _ --- - _. TYPE OF OCCUPANCY residence
ADDRESS1229-5 5WTi_—Vett _Pla.ce
DWELLING UNITS -- - -- -_ 1 FIXTURE UNITS _
SURCHARGE IF APPLICABLE
PERMIT FEE —_575'_ _._, If,JSPECTION FEF �5-_—_ TOTAL DEPOSITED --600.
(NEW) (EXISTING) BUILDING SEWER SYSTEM Fanno_.Lree.k--- -.-----_---_
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT �7
SEINER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE -- _----_—._-- INSTALLER
RECEIVED t ' L
(AGENCY R ITS AGENT)
i
ISSUED
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COMN1ENTS:__ Paid Leron Heights-6150,00 Sewer Permit Ont
This Application and permit expires in one hundred and twenty (17-0) days.
The amount paid will he forfeited should expiration occu,.