11370 SW WATKINS AVENUE 11370 SW WATKINS AVENUE
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�► SEWER PERMIT
C' Unified SewerageAg.�ncy
of Washington County ITY OF �i - DATE .
OWNER: 1GVeg_04 � G.r- _ PHONE39-•��o��
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
0 SIDE SEWER ❑ LINE TAP AND SIDE SEWER Q LINE TAP
TYPE OF OCCUPANCY:
❑ NEW ❑ EXISTING SINGLE FAMILY COMMERCIAL.
WEXIST. (PRIOR 1-0 7- 1-70 ) ❑ MULT. RES. ❑ INDUSTRIAI_
FIXTURE UNITS_ DWELLING UNITS
ADDRESS OF STRUCTURE :
Perml! Conditions: The applicant agrees to comply with all miles and regulations of the Unified Seworage Agency, `r
When calling for Inspection, please refer to the Permit Number. The Application expires in one hundred twenty (120)
days. The amount paid will be forfeited should expiration occur.
The Ardency dues 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 currert charge and the Agency
will install a lateral at the location specified by the installer.
FEES:
G J
� 3�'T FEE Es_
i' CONNECTION CHARGE
lLINE TAP INSTALLATION
_
OTHER ISSUED BY
TOTAL $ 3J-
APPLICANT DATE
SEVIER PERMIT
N 2
ADDRESS OF STRUCTURE _ 3 �:2
TAX MAP .251 - 'FDA _ TAX LOT � 0� SYSTEM
LOT ___9 --BLOCK _ _ - OF Ea JaI 14
1/ti AP-1
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FP 1VED BY � D44
ISSUED BY DATE
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