10330 SW HILLVIEW STREET I
10330 SW HILL VIEW STREET
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SEDER PERMIT N° _
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Unified Sewerage Agency _�,Z,•�/ -
of Washington County C.f.,Y OF DA I i
OWNER -
OWNER 'S
WNER :OWNER 'S ADDRESS: I0Q �Lt.�_ )I��Gk! �•
TYPE OF INSTALLATION:
SIDE SEWER ❑ LINE TAP AND SIDE SEWER LINE TAP
TYPE."`C'}=;OPCCUPAiNCY:
❑ NEW ❑ EXISTING SINGLE FAMILY L.] COMMERCIAL
EXIST. (PRIOR TO 7- .--7n ) ❑ MULT. RE- S. ❑ INDUSTRIAL
FIXZURE UNITS___ DWE:I_LING UNITS—
ADDRESS OF STRUCTURE : --------
Pennit Conditions' The applicant agrees to comply with all rules and regulations of tha !.;,,',fled Sewerage Agency,
Whcn calling for Inspection, , lease refer to the Permit Number. The Application expilas in one hundred twenty (120)
days. The amount paid will be forfeited should expiration occur.
The Agency does not guarantee the accuracy of the location of sine sewer laterals. if the sewer is not located at
the measurement given, the installer shall prospect three feet in all di•ections 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 location specified by the Installer.
FEES:
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00
EP,MIT FEE $
CONNECTION CHARGE __ 700 , 00
LINE TAP INSTALLATION
ISSULD BY
0 T H i-R 2
TOTAL g 32.sro0
APPLICANT � DATE
SEWER PERMIT No
ADDRESS .OF STRUCTURE _- 10 S50_
T-A X MAP 0S I r Acx, ____ TAX L O T _-_ '� _ S Y S T E M
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APNROVED BY DATE
DISSUED–FAY DATE
D. U . 'S R F'M A R K 5 .►/'/
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