15285 SW 100TH AVENUE-1 15285 SW 100TH AVENUE
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INSPECTION NOTICE
City of Tigard Building Drpartmenw
12420 S.W.Main St.
Tigard,Oregon 97223
Phone: 639.4171
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Type of Inspertiori 1..r e'
Date Requested__-��- �____. rime-,< A.10.
Address Permit *,Ue
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Owner-- -- — __—_ Lot -
Builder —
The following 5uilclinq Code deficiencies are required to 6e corrected.
Preswed to m _�_ ___ Approved
Ll Inspector �J f3i approved
Date
CALL FOR REINSPECTION
❑ YES NO
INSPECTION NOTICE
City of Tigard Buildirn,Department
12420 S.W. ^rain St.
Tigard, Oregon 97223
Phone:: 639.4171
Type of Inspection
Date Requested
Time A.M._15.
Address r �`' ��' % `—? —__ Permit 4—
Owner---
tOwner—_ - Lot # --
Builder ----.---�.^_---The following Building lode deficiencies are requ red to he corrected:
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Presented to _ _> Approved
Inspector -- _ Disapproved
Date -
CALL FOR REINSPECTION
[�� YES ❑ NO
SEWER PERMIT w': 2718'k►
UfniSewerage Agency
of Washington County CITY OF /!��/�'O DATE
OWNER : C�.�',y .i "5 ��//J� � PHONE
OWNER ' S ADDRESS:
TYPE OF INS'+ ALLATION:
W SIDE SEWER ❑ LINE TAF' AND SIDE SEWER Cj LINE TAP I
TYPE OF OCCUPANCY:
❑ NEW ❑ EXISTING ❑ SINGLE FAMILY ❑ COMMERCIAL
EXIST. (PRIOR TO 7- 1-70 ) Q MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS / DWELLING UNITS
ADDRESS OF STRUCTURE : "y
Permit Conditions: The applicant agrees to comply with all rules and requlations of tho Unified Sewerage Agency,
When calling for inspectioi, please refer to the Permit Number. The Application expires in one hundred twenty 0201
days. The amount paid will be forfeited should expiration occur.
Th„ Agency does riot yLarantee the accuracy of the to ration of side sewer lalarals. If the sewer is not located at
the measurement given, 'lie 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. i
FEES, 1�
PERMIT FEE S
CONNECTION CHARGE
LINA TAP INSTALLATION
ISSUED BY
OTHER
TOTAL. $
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APPLICANT DATE
t SEWER PERMIT N ! 27 1 S6
t V,IL8F:!!' FOR THIS PERM11.
ADDRESS', OF STRUCTURE /�-�-��.�.? �� 'fi • c=7�_7
TAX MAP 2S'I- // B TAX LOT SYSTEM '•^��
LOT BLOCK [1F
APPROVED BY DATE ISSUED BY [)Alf
D. U . ' S RE 4AR K5 ._"•'i.�, . ,.1..i;i/'E'• �/� 'T/�� i/,�t�+.
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CITYOF TiGARD
WASHINGTON COUNTY,OREGON
NAME: Gary Srh lz
ADDRESS:_ 15285 S{d 100th Sewer 1'urml�186
Our records show your home was recently connected to
sewer. State law requires, when a septic tank, cess-
pool, e'tc. . . . . . . is abandoned, it be pumpe.' out and
filled with sand or gravel, or be removed completely.
An inspection by this Department is required for
verification. As of this date, our records show no
such inspection.
Please have this situation corrected and notify this:
Department.
Thank you.
Tigard Building Department
-- 12420 5.W. MAIN P.O. BOX 23397 TIGARD, OREGON 97223 PH; 639.4171