12550 SW 124TH AVENUE r J
• S74 124TH AVENUE
41"
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Address j,2 S5(.� s, l.� . J QA Permit No,
_ Permit charge
v, r Connection fee
Paid by
Type of bUllding r j_ Date connected___;-7f
Service rate / M Inspection fee z5 _
Contractor_ C .x,:tLT lex Paid by Date_ '
Size of connection �� Assessment Pa-id
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PERMIT TO CONNECT
Tigard Sanitar.y Dia trict 3 5' s
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PERMIT N° 1425" DATE
PERMIT IS GIVEN TO
T^ VO":nECT A
TO THE SYSTEM OF TIGARD SANITARY DISTIaCT
AT r f
THIS PERMIT MUST BE POSTED Olv ^ISE DKRCRIBED PREMISFS UNTIL CON-
NECTION IS MADE AND INSPECTIO1 vF CONNFCTION HAS BEEN COM-
Pi ETED.
PERMIT FEE PAIR $.........a.t..+...................TIG.1R:, SANITARY DISTRICT
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CC.KNE(*fInN INSPRCTED .UNli A41!11cPVED
Date S�iiuriulrndent
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