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SEWER PERMIT X1.) 219i)9
U
Unified Sf werage Agency CITY OF __—.� DATE
of Wash;-gton County
PHONE :
OWNER . ��•r�
OWNc-R ' S > G
TYPE OF INSTALLATION:
[O" BUILDING SEWER [] BUILDING SEWER AND SIDE SEVER
TYFF OF OCC:JPANC' .
El NW SINGLE FAMILY [] COMMERCIAL
~_s:_-- T. (PRIOR TO 7-1-70 ) F1MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS __ DWELLING UNITS
ADDRESS OF STRUCTURE :
PERMIT CONDITIONS: THE APPLICANT AGREES TO LOMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR INSPECTION,
PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION EXPIRES IN ONE-
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR .
FEES:
PEPMIT FEE '-- -- -
CONNECTION CHARGE
SIDE SEWER LNSTALI_ATION -- ISSUE0 BY
OTHER --
TOTAL $
- APPLICAN"i DATE
SEWER PERMIT Na 21999
ADDRESS OF STRUCTURE
ij� :
TAX MAP / -S � - 3 �'' '- � TAX LOT � � SYSTEM /Li>2���.y�
LOT 0 BLOCK „ OF
AFPROVED BY DATE ISSUED BY DATE
D . U. ' S _ % REMARKS ri c Ti�i�,-��- ���,:,5 r 73� �� c21,.L_