11200 SW 72ND AVENUE-1 11200 SW 72ND AVENUE
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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 9722.3
Phone: 639-4171
Type of Inspection ----
Date Requested 7—_�' Time.- A.M._ P.M.
Address --_- - /2.Q r7 ��� ��- Permit #-----___--�
Owner_— —--- -- lot #. _---- ---
BuilderThe following Building Code deficiencies are required to he corrected:
--------------
Presented to _- - -- - --- Approved
Inspector __� — Disapproved
Date
CALL POR REINSPECTION
D Yea LR NO
SEWER PERMIT
Uf fied Sewerage Ag Icy G
of Washington County CITY OFY ��- DATE
OWNER : _�`�1,F l c- lam.'a-e, lam: ��1�<d.����J.e� � P H 0 N • -1-2
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OWN'-R 'S ADDRESS: �h�c 'L'
TYPE OF INSTALLATION:
C❑ S-.q4E SEWER ❑ LIPIF TAP AND SIDE SEWER L] LINE TAP
TYPE"-Of,iK-QUPANCY:
❑ NEW n EXISTING •SINGLE FAMILY COMMERCIAL
❑ EXIST. (PRIOR TO 7-- 1- 70 ) LJMULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS — DWELLING UNITS
ADDRESS OF STRUCTURE : i Y� r' c _ :�_��' • <* -�+-•l" :=�rc-<_ 'G�-f �t�
Permit Conditions: T'he applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
When calling for Inspection, please refer 1) the Permit Number. The Application expires in one hundred twenty (120)
days. The amount paid will be forfeited !311ould 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:
oa
PEOMIT [--F $ �S
CONNECT ION CHARGE 7o7c� as
LINE TAP INSTALLATION
ISSUED BY
OTHER
TOTAL $
APPLICANT f T DATE
-V
SEWER PERMIT No 23332
ADDRESS OF STRUCTURE d S` LLQ ,,? is W &t4-•f
TAX MA`P J .r, L 3 "4 TAX LOT / 3yy SYSTEM
LOT BLOCK OF
' APPROVED BY DATE ISSUED BY DATE
D.U. 'S RENARKS
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PERMIT TO CONNECT
Tigard Sanitary District
PERMI'!' N� 12'477 DATE L - V
PERMIT IS GIVEN TO r
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MALE AND INSPECTION Ch 4�10NNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID ;...,, .�`Q.,.�;......•.TIGARD SANITARY DISTRICT
CONNECTION INSPECTED ANP APP70VEl
-------_Date - Superintendent
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ADDRESS _( I gado .' :Z PERMIT NO._ j- _._.
PERMIT CHARGE none
OWNER CONNECTION FEE
PAID BY
TYPE OF BUILDING DATE CONNECTED
5ERVICE RATE f � INSPECTION FEE
CONTRACTOR J PAID BY DATE
SIZE OF CONNECTION A55ESSMENT PAID