11705 SW ANN STREET-1 ' t
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11705 SW ANN STREET
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INSP�:,';InN K)ACE
City of Tigard Building Department
12420 S.W.Main St.
Tigard,Oregon 97223
Phone: 639.4171
Type of Inspection
Date Requested_�! ) Time _. A.Ni.— `�.P.M.
Address f r'1 J7 / r(, — Permit #_
Owner _ Lot #
Bt oder
The following Building Code deficiencies are required to be corrected.
Presented to Approved
Inspector ------ ❑ Disapproved
Date
CALL FOR REINSPECTION
YES ;? NO
Addrec 11705 S.W. Am St. Permit No. 1571
Permit charge
Owner Dutton F. Brown Connection fee 300-00
Paid by_--_Dalton F. Brown
Type of building__Residun,?e Date connected 2-4-72
Service rate 9.00 Inspection 25.00
Contractor Paid by ---- -)a 1,P,
41,
Size of connection Assessment— Paid
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PERMIT TO CODTNECT
Tigard Sanitary District
PERMIT N�) 1.5 rl1 DATE
PFRMIT IS I WEN TO
OF
TO CONNECT A
TO THE SYSTEM OF UGARD SANITARY DISTRICT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED,
PERMIT FEE PAID
.............. .........TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
Date---
Supprtntem ent