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7325 SV FAN',10 CREEK DRIVE 10
SEWER PERMIT
Ur,i'iedSew rageAgency
of Washington CITY OF
DAl
OWNER: ` � � __- -- PHONE : G �=
OWNER 'S .ADDRESS:
TYPE OF INSTALLATION:
IDE SEWER SEWER ❑ LINE TAP AND SIDE: SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
❑ NEW EXISTING ❑ SINGLE FAMILY COMMERCIAL
❑ EXIST. (PRIOR TO 7-1-70 ) ❑ 1• ULT. RES. ❑ ;NnuSIRIAL
FIXTURE UNITS____. DWELLING UNITS
ADDRESS OF S'CRUCTURE : -40 VOW4- 73 _�� �Av, K eaw
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
When calling for Inspection, please refer to the Permit Numb^r. The Application expires in one hundred twenty (120)
da,.,s. The amount paid will be forfeited nhaild expiration occi.r.
The Agency does n%t guarantee the accuracy of the location of side sewer laterals. If the Bawer is not iocated at
the measurement given, the installer shall prospect three feet in all directions from the distance and depth given.
It 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 vocation specified by the Installer.
FEES:
FEE s� s
U C ION CHARGE
JANE
TAP INSTALLATION _ _____
ISSUED BY
O1 H E R
TOTAL
APPLICANT �^- r DATF
SEVIER PERMIT 73� Sw-AMxe) a Poor ,'
ADDRESS OF STRUCTURE
TAX MAP � � I I� D _ TAX LOT _��d� SYSTEM �l!�4
LOT --BLOCK OF
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TP-PROVED BY { DATE ISSUED BY� DATE
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