12370 SW BROOKSIDE AVENUE 1
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12370 SW BROOKSIDE AVENUE
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Address ,3 _ Permit No. 1 /
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Nam.,.Df Occupant _ __ Permit charge_
Connection fee_L-'j_JtjQ
------ _ Paid by � � �-
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Date connected—/J---
Type
onnected—/J---Type of Building Inspection fee d C4
Service Rate_ ___ Paid by `� '�' Date
Contractor r � __ AsFsaansnt_T__ Pnid/ — _
Size of
PERMIT TO CONNECT
Tigard. Sanitary District
PERMIT N9 669 DATE
PER51IT IS GIVEN TO
OF
T7 CONNECT A r
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT C:r.
T1115 PERMIT MUST HE POSTED ON THE DESCRIBED PREMISES UNTIL.CON-
NECTION IS MADE ANI) INSUECTION OF CONNECTION HAS BEEN COM-
PLETED.
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PERMIT FEE PAID $....................................TIGARD SANITARY DISTRICT
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- ----- - - ----- - --
CONNECfION INSPECTED AND APPROVED
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Date Supelntendent
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