9720 SW MURDOCK STREET X720 SW MURDOCK STREET
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PERMIT N 0. �---
ADORE5S �7"0 ;'" •� �
PERMIT CHARGE __. 1
72
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COidNECTIOfv FEE
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OW N E R -------'
PAID By
DATE CONNE , CED
TYPE OF BUILDING _ !
INSPECTION FEEg --- -----�
SERVICE RATE ------- ----
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PAID BY
CONTRACTOR _— DATE
(r ASSES ii'1EN7 PAID
SIZE OF CONNECTION ,,,_ _ ________-.-_-_ =- r^
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R A G E AG F-N C Y NO 9560
UNIFIED N'TY DATE
'."JASHING-l"ON COU
CITY
APPLICATION FGR SEWER CONNECT-ION PERMIT
OWNER:
OWNER'S ADDRESS:
n__ STREET 97223 -ZIP
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-Tiq#rdj--- TATE
CITY 1113 D
ADDITION�-5-1-
BUILDING SITE: LOT. BLOCKf.
TYPE OF OCCUPANCY rpsidence
I AX LOT NO,
9720 S. __Mu:�doclk St.
ADDRESS
DnELLING UNITS FIXTURE UNITS
SURCHARGE IF APPLICABLE
PERMIT FEE , - 300 INSPECTION FEE 25_ TOTAL DEPOSITED
(NEW) (EXISTING) BUII.DING SEWER SYSTEM ------
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT
SEWER PERMIT
i-IJIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZF 1_411 INSTALLER — Schmidt- -Exca-v.at-,ing ------
RECEIVED
(AGENCY OR ITS AGENT)
COMMENTS: soijar permit only ---
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.