10210 SW BROOKSIDE PLACE I
C
N
V7
E
W
.y
a
CL
b
r
I
r
i
10210 SW BROOKSIDE PLACE
Address Lu. P/Permit No. 7.:5
Name of Occupant /'�i/1f n��•f/f e7— Permit charge do
s
Connect.on fee r✓Win•o�
_ Paid by �s/ilIES lfii//e c k-
-- —_ Date connected. #'AA
Type of Building Inspection fee
Service Rate � 7 r Paid by :T, (,C���/���'�Uate ��►{%
Contractor_ �i/i�C� �� i����ir Assessment Paid
Size o.' connection
PERMIT TO CONNECT
Tigard aanilary District
PERMIT N° 7 5� t)ATrX. 4._.-3.-Lr?L. 4�_
PERMIT IS GIVEN TO,__�04--j
OF/
TO CONNECT A
-
/ r� _J 'Lf ✓---__.____.__
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DE4CRIBF.D PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $Oe .:�...................... 5
�s
B��•� tit--2"'-•-t-F-•..,�
CONNECTII)N INSPECTED AND APPROVED
Date _ --- —Superinten3tnt -