12185 SW SUMMER STREET 12185 SW SUMMER STREL3'
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f- SEWER PERMIT N"> 2,1999
unUified Sewerage Agency DATE
of Washington County(� \ CITY OF - ern
OWNER : _\`QID1� kS _ PH0VE : 6e24)" ''�� /`�
OWNEk 'S ADDRESS :
TYPE OF INSTALLATION:
0 BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE -'F OCCUPANCY:
❑ NEVA \CiSINGLE FAMILY ❑ COMMERCIAL
[I� EXIST. (PRIOR TO 7-- 1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE_ UNITS DWELLING UNITS_,_,
ADDRESS OF STRUCTURE : A�w 9— --- --
PERMIT CONDITIONS: TF!E APPLICANT AGREES TO COMPLY WITF ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR INSPECTIO.
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:
PERMIT FEE $ �✓
CONNECTION CHARGE
SIDE c)LWER INSTALLATION �^
ISSUED BY
OTHE', ---
TOTAL $ 3 2-b�
r APPLICANT DATE
50
SEWER PERMIT
ADDRESS OF STRUCTURE
TAX MAP 1 .� TAX LOT ��� SYSTEM
LOT .3 BLOCK _ OF 4c
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APPRO -D BY DATEISSUED 3Y DATE
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D. U. 'S 1�--- REMARKS Y �� T�$ •� v f S�" �Q Ctr�Q
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