10895 SW PARK STREET 10895 SW PARK STREET
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S� a2 Permit No.
Permit charge
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sari/ice rate / � ;nspection fEe o1 -----
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Contractor
ize of connection —
Assessment — ___ Paid __
SEINER PERMIT
N 12143
Unified S^overage Agencu
cf WashingtonCounty CITY OF_ Tigard _ DATE 4-22-•77
OW1)i-R, David--Mc_ Elheran
— — — � PHONE , 620-5736
OW11f.R 'S AUURFSSr 10896 SW Park
jyj,L OF INSTALLATION •
WWJILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
yj-1 OF OCCUPANCY,
rW SINGLE FAMILY ❑ COMMERCIAL
�t / IST . (PRIOR TO 7-1-70 ) ❑ MULT . RES. ❑ INDUSTRIA'_
FIXTURE UNITS____ __— DWELLING UNITS 1
FL I,1/I T CONDITIONSs THE APPLICANT i-,r,REES -TO COMPLY WITH ALL RULES
441, REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR
IN. f•F_CTION, PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION
11,pJOES IN ONE-HUNDRED AND TWENTY ( 120 ) DfAYS . THE AMOUNT PAID WILL
ag 11JRFEITED SHOULD EXPIRATION OCCUR.
1[ ( ', $
Fr i.,MIT FEE $ 25.
C,(1NF_CTION .:HARGE 300.
L ? GE SEWER INSTALLATION
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APPLICANT '/ DATE
SEWER PERMIT M 12143
SS OF STRUCTURE X08.895_5 Park
TAX LOT sJauo SYSTEM Fanno Creek
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