11500 SW 115TH AVENUE 11500 SW 115TH AVENUE
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E ddrdcs ,f/ S�oG .5:.,v /(S` 74 Permit No.
Permit charge -7y e--
Owner ���,.� ,�"71d t���_ t_ Connection fee TUU
Paid by k c'ji y}'I G�Lv1-am t
Type of building -tom d Date connected
Service rate In„pection fee
Contractor Paid by date
Size of connection ..___�. Assessment Paid
UFN
SEWER PERMITni
i.yr I.
Unified Sewerage Agency
of Washington County CITY OF DATE January 4, 197B'
OWNER: Q Mal- ssPtt.e — PHONE : 946-ggwi
OWNER 'S ADO)RtSS: P. O. Bad 53 G. n Home , _nrpnnp
TYPE OF INSTALLATION :
! ❑BUILDING SEWER rIBUILDING SEWER AND SIDE SEWER
I
TYPE OF OCCUPANCY:
®NEW
SINGLE FAMILY ❑ COMMERCIAL
❑EXIST . (I'RlnR TO 7-1--70 ) ❑ MUL_T . RES. ❑ INDUSTRIAL
FIXTURE UNITS DWEI..LING UNITS 1
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATION`'i OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER. 'PHIS APPLICATION
EXPIRES IN ONE—HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL
13E F1,)RFEITED SHOULD EXPIRATION OCCUR.
FEES:
PERMIT FEE a i�. 00
CONNECTION CHARGE (,00. 00 r
SIDE SEWER INSTALLATION PJR
ISSUED BY
OTHER
TOTAL s . 625. 00
i- 4Jan. Q. 1978
APPLICAN DATE
{NOTICE: LCLGAr8 OF THE
AMPI ELATE. SEWER $EH�JICF
rraan E WILL BFI;( Enp THIS SEWER PERMIT IN° 13864
prpt�!r
ADDRESS OF STRUCTURE 11500 5W 115th. Tioard, Drepon 9722.3
TAX MAP -- TAX l_UT _ _ SYSTEM
LOT BLOCK OF
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APPROVED BY DATE ISSUED BY ATC:'
REMARKS separate check-Leron Height3$15O. 00