12235 SW SUMMER CREST DRIVE 1223' SW SUMMER CREST DRIVE
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Receipt # S-7,Z3
SEWER PER lil'�' 'v : ,> > ��t►4
Unified Sewerage Agency
of Washington County �TTY OF _ Tigard _ DATE 5/15180
PHOS lE : 639-6716
OWNER : _ l,a,�,s .1.,, r o� n _
OWNER 'S ADDRESS: 12?35 SW Summercrest Drive ---
TYPE OF INSTALLATION:
BUILDING SEWER ❑ b'JILDING SEWER AND SIDE SEWER
TYPt7 OF OCCUPANCY:
[� NFW Cx1 SINr,LE FAMILY [] COMMERCIAL
[( EXIST. (PRIOR TO 7- 1-70 ) MULT. RES. INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1 _
ADDRESS OF STRUCTURE : _1223-5 SW _Summercrest.. Qriya
PERMIT CONDITIONS: TH_ APPLICANT A;RECS TO COMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR INSPECTION ,
PLEASE REFER TO THE PE11MIT NUMBER . THIS APPLIC-�TION EXPIRES IN jNE-
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT 'AID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR.
r-EESs
PERMIT FEE $ 2.5. 00
CONNECTION CHARGE 300. 00
SIDE SEWER INSTALLATION Penny Liebert
ISSUED BY
OTHER
TOTAL $ 325. 00
5/15/80
NOTICE' _-W_ 11YS (1c TIDE APPLICANT DATE
H`GVC GATE. Srlt/ER SERVICE
CHARGI: WILi. BEGIN FOR THIS SEWER PERMIT *T
r1, �
pc1. T. 1�9 04
ADDRESS OF STRUCTURE _ 1223`1 SW Summercrest Orive
TAX MAP 1S1-34CB TA,, LOT _2300 SYSTEM Fanno [ reek
LCT 14 BLOCK _ OF Summer Hills Park
DWH --5/15/80 _ _�1 5/15/8rl
APPROVED BY DA''E ISSUED BY DATE
D . �_! . Is 1 REMARKS Pum& fi.11. existing r,eptic tank ear State Code.
i_eron Heights Sewgr Surcharge of $].50. 00
Unified Sewerage Agency - DATE _ 40 1f 1�
of Washington County CITY OF _ � --
OWNER : — rA - am" L . I?jcpA vj_ _ PHONE :
OWNER ' S ADDRESS : W ��'^'�'pj 8� *�^ • --
TYPE OF INSTALLATION :
0 BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWED
TYPE OF OCCUPANCYt
❑ NE'rl S:NGLs: 7AM I LY ❑ COMMERCIAL
( EXIST. (PRIOR TO 7- 1-70 ) ❑ ti:ULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS----- DWELL .[',IG UNITS
ADDRESS OF STRUCTURE: : 4�aug ,
PERMIT CONDITIONSt THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR INSPECTIOP,I ,
PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION EXPIRES IN ONE -
HUNDRoD AND TWENTY ( 120 ) DAYS. THE AMOI-TNT PAID WILL BE FORFE17ED SHOULD
EXPIRATIOri OCCUR .
FEES:
PERMIT FEE $
CCN LECTION CHARGE z�
SIDE SEWER INSTA LATION
_ ISSUED BY
O T H E R __--
T O T A L $ A
- -�—v APPLICANT --_^�-- --- DATE
7,2
iw1��n p � �
ADDRESS OF STRUCTURE
TAX NIAP I5 _ 3'I TAX LOT 2300 SYSTEM
L 0 T BLOCK _ OF
APPROVED BY DAT�Ej ISSUED BY ,.D�A'T-ED ,,���
D . U . ' S REMARKS Y'u��� 2X i�: ��• SP��tfc �w�'YR�9 `.0