10365 SW PARK STREET SW PARK STREE?T
0
Y
I
TINSPECTION NOTICE
City of Tigard Building Department
12.420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection -A
Date Requested 5�Z-1 Time A.M.
Address �p if 44oe� d 1A- Permit
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
ra
Presented to L] Approved
Inspecta, ❑ 1011upproved
Date
CALL FOR REINSPECTION
YES 0 NO
U
--- SEWER PERMIT
Unified Sewerage Agency CITY OF _ DATE �2e"_—'_�_�--
Of Washington county
�¢b ,,o,.,�,�_be� P H�7NE
OWNERS �I
OWNER 'S ADDRESS: _L00�'�
TYPE OF INSTALLATION:
�] l_!"lE TAP AND SIDE SEWER L� LINE TAE'
❑ SIDE SEWER
TYPE OF OCCUPANCY:
[_] NEW ❑ EXISTING SINGLE FAMILY r] COMMERCIAL
EXIST. tPRIOR TO 7-1-70 ) ❑ MULT. RES. ❑
INDUSTRIAL
FIXTURE UNITS _— DWELLING UNITS
ADDRESS OF STRUCTURE : _ — ���' - —
the Unified Sewerage Agency,
Permit conditions: The applicant agrees to comply with all rules and regulations of
When calling for inspection, please refer to the Permit Number. The Application -xpires in one hundred twenty (12"0)
days. The amount paid will he 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 �IPermit atrections f the curom re It charge and the Agency
stance and depth given.
If not so located, the Installer shall purchase a 'Tap and Side Sewer
will install a later.-+, at 4he location specified by the Insta;ler.
r FEES: 3 ��re�0
PERMIT FEE s —"
CW4NECTION CHARGE - —
N TAP INSTALLATION7 — iSSUEU BY
(-HER
TOTAL
-3 -�-�---
APPLICANT DATE
SEWER PERMIT
ADDRESc; OF cTRUCTURE _j 3 p ��L-
I �
---
TAX MAP �y SYSTEM
TAX LOT -
LOT �ELOCK _ OF
ISSUED B Y —J — DATE
it APPROVCD BY DATE
SII cK��� . S4, aj'.
D.U. 10S NQ. REI4ARKS q me, � - — _