12485 SW BROOKSIDE AVENUE A IRS y
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12485 SW BROOKSIDE. AVENUE
Permit No.—
Name of Occupant Permit charge CO
-_-----_-_- --� Connection fee '�•�rlr`°r
- - —- Paid by J �� /I/e e/Y
Date connected_ � [3
Type of Bui]dinR. SilrE�t'CE Inspection fee %r' F`
Service Rate^— �'�`.` -- - P,id by J G��i//�'c .0 Date -L/2-1,113
Contractor J- �t// //e c /t Assessment Paid
Size o$ connection
1
PERMIT TO CONNECT
Tigard Sa.n..i lax-y Iii sirict
PERMIT h19 7211DATB
PERMIT IS GIVEN TO -
OF
1
TO CONNECT A ' -Af__' 4
TO THE SYSTEM OF TWARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLFTED.
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PERMIT FEE PAID s.......g.....�w..�.........TIGARD 84LNITARY DISTRICT
By
CO"r•NECTION INSPECTED AND APPIAOVED
A-
Date Y-- — �Su4e..