12305 SW SUMMER CREST DRIVE 1235 SW SUMMER CREST DRIVE
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SEWER PERMIT
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Unified Sewer.ge AgencyO�
of Washington County CITY OF \l rJ"U�_ DATE
LCit`f l VIS U V0
OWNER : _ .� PHONE ,—
OWNER 'S ASDRESSI ._ x3c.' Sot� n
TYPE OF INSTALLATION:
KSIDS SEWER ❑ LINE TAP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
[] NEW ❑ EXISTING XSINC•LE FAMILY [] COMMERCIAL
1EXIST. (PRIOR TO 7- ) -70 ) ❑ MULT. RES. [] INCUSTRIAL
FIXTURE UNITS_ DWELLING, UNITS_�1��
ADDRESS OF STRU:TIIRE : 4 o e,.
Permit Conditions: The appilcant agrees to comply with all rules and Regula!►rn•s of the Unified ;-ewerage Agency,
When call;og for Inspection, please refer to the Permit Number. The Applicatioi, expires in one h:mdred twenty 1122,'
days, The amount paid wil, be lurfelted should expiration occur.
The Agency doer not guarantee ti-iie curacy of the location of side sewer laterals. If the sewer is not located u t
the measuremen tilven, the Installer shall prospect three feet In all directions from the distance and depth given.
It not so located, the installer shall purchase a 'Tap an.` Side Sewer' Permit at the current charge and the Agency
will Pest-ill a lateral at the location specified by the installer.
' FEESt
PERhIT FEE
CONNECTION CHARGE 00, U
LINE TAP INSTALLATION Y-
OTHER ,
IcSUED BY
NOTICE. O-ys of HIE
p,8g,jE DATE, SEWER SERVMETOTAL --
CH,kRGE WILL. BEGIN FOR .THIS
PERMIT.
APPLICANT DATE
SEWER PERP" IT
ADDRESS OF STRUCTURE _ 9_)
TAX MAP '34 CA TAX LOT z�C7 U SYSTEM
LOT BLOCK OF
APPROVED BY DATE ISSUED BY DATE
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L/h �- REMARKS -044 4���•- -