12240 SW SUMMER CREST DRIVE 12240 SW SUMER CREST ijRIVE
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INSPECTION NOTICE
(;ity of Tigard Building Department
12420 S.W. Main St.
Tigard, Oregon 97221
Phone 639.4171
Address ------..-- - - - ____. _____ - _ Pirmit
Type of Inspection __ _ __— -_—.
The following Building Code deficiencies are rrquirecl be cornicted: .Presented to to _ -.-_-�- -��-- Inspactor
Date
CALL r(.,,R ;,,E1N PE-C T10N
C� y Gl No
Recei.pL #5656
SEWER PERMIT 21199
Unified Sewerage Agency
of Washington Cointy CITY OF Ti cla rd _ — DATE 5/5/80
0V,NE-.R : Dallas Miller PHONE : 62.0-2461.
OWNER ' S ADDRESS : 12240 SW Summercr, est Drive _
TYPE OF INSTALLATION:
BUI
El LDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
❑ NEW ❑ SINGLE FAMILY ❑ COMMERCIAL
❑ EXIST. (PRIOR TO 7-1-7 ) ) ❑ AULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS__ _ DWELLING UNITS
ADDRESS OF STRUCTURE : 12240 SW bummercrest Drive _
PERMIT CONDITIONS: THE APPLICANT AGREES TO CO'•iPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY. WdEN CA!.LIN(. 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 OC; UR .
FEES:
PERMIT FEE $ 25. 00 _
CONNECTION CHARGE 300. 00
SIDE SEWER INSTALLATION _ Penny Liebertz
ISSUED BY
OTHER
TOTAL 325.00
5/5/80
APPLICANT DATE
�r
e f,
VWA. cEl'_;1 Ful, Tli:3 SEWER PERMIT
PEH,.11T. N? 2 i 1 .99
ADDRESS OF STRUCTURE 12240 SW SummFrcrest Drive
TAX MAP — 1S1-34CB T.AX LOT 27 SYSTEM Fanno Creel;
LOT BLOCK OF
OCR 5/S 80 _ _n1 _��80
APPROVED BY DATE I55U=D BY DATE
Ll . U . ' S 1 REMARKS pump & Fill spetic tank fuer State Code.
Minimum 4" pipe required.
--Y�A ALSO LERON HEIGHTS SEWER 6URCHARGF_ OF $.150. 00
1 ; GIIh \✓-1
N .1
Unified Sewerage Agency
of Washington County CITY OF DATE
0 W N E R . —_, � ��'--C cr---r '1- - -,- mac _ P H 0 N E
0WrlER ' S ADDRESS : /.-<.' - ;,-U -'�
TYPE OF INSTALLATION :
❑ BUILDING SEWER ❑ BUILDING SEWER AND SIDE SE.WER
TYPE OF OCCUPANCY :
FI NEW SINGLE FAMILY ❑ COMMERCIAL
EXIST. (PRIOR TO 7- 1-7'J ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS _ DWELLINC UNITS
ADDRESS OF STRUCTURE : Z.Zyy
PERMIT COADITIONSt THE APPLICANT' AGREES TO uMPLY 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-
HU DRED AND TWEfITY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR .
FEES :
PERMIT FEE S .Z _3 ' •
CONP.ECTION CHARGE 21
SIDE SEWER INSTALLATION
,f> ISSUED BY
OTHER
TOTAL
�D APPL ICAN I DATE
SEVVER PERMT
ADDRESS OF STRUCTURE `zy ='' / �_. _ 1�0
TAX MAP _,�1-' -3 y_ef'z4�� TAX LOT _ .,tom j SYSTEM
LOT BLOCK OF
APPROVED BY DATE ISSUED BY DATE
D . U . IS R E M A R K S __1 t'ra►�t. �',� �' .tel': t r ��'