12280 SW SUMMER STREET WLWM
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INSPECTION NOTICE
City of Tigard ;.,gilding Department
1242J S.W.Main St.
TigarJ,Oreynn 97223
Phone: 639.4171
Type of Inspection 31
Date Requested—i J 6 Thne'c"2r'o' _ M.—P.M.
lf;f 7 Permit
Address — —
Owner
Lot #
Builder _ -----_--- --_--- __
The following Buildine Code deficiencies are required to be corrected:
Presented to ___ —. --_ — Approved
Inspector �_ �— --- U Disapproved
Date
CALL FOR REINSFECTION
C7 YES Il NO
r @ � PERMIT
unified Sowerage Agency
v
of WiashingtonCounty T1 Y OF T .-_____. DATE
OWNER _L�t ~ /A o_e_- t' R(AV PHONE G 3►t-ga yL
OWNER ?ESS: AtZ-150
TYPE OF INSTALLATIONt
SIDE SEWER ❑ LINE TAP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCYt
❑ NEW ❑ EXISTING SINGLE FAMILY ❑ COMMERCIAL
T9EXIST. (PR:OR TO 7- 1-70 ' ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS__ DWELLING UNITS_ btl el
ADDRESS OF STRUCTUREt bo,Q_
Pe,7nit Conditions: T)fe applicant agrees to comply with all rules and regulations r;f the Uriffled Sewerage Ager
When calling for Ing pection. please refer to the Permit Number. The Application expires In one hundred twenty (120)
days. The amount paid will be forfeited should expiration occur.
The Agency does nod guarantee the accuracy of the location of s'de se%eer laterals. If the sewer Is not Incated at
the fnaa,;urern int given. the Installer shall prospect three feet in all directions from the distance and depth given.
It i t ro located, the Installer shall purchase a 'Tap and Side Sower' Permit at the current charge and the Agency
will Install a 14lesal at the location specified by the Installer.
FFESt
r EAMIT FEE. f` _ �00
CONNECTION CHARGE
LINE TAP INSTALLATIUN —
ISSUED BY
OTHER
TOTAL
APPLICANT _ DATE
SEXIER PERMR IT
ADDRESS OF STRUCTURE kove_ -
TAX
MAP 3�_ G 6_ TAX LOT 13 019 ^� SYSTEM �`A�__ D ►-
LOT Z___B L 0 C K �. 'J F __guom Rei
APPMOVED BY DATE ISSUEot
DBY ` JD-ATE nn
D. U. 'S QST _ RENARKS Gf ,M H p. P t� s7R, CoKQ.___
04-6-Te . -