12565 SW 124TH AVENUE I�
12565 SW .124TH AVENUE .�
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Address / �,�L�- / _ Pe rm'.t No._ /012
Permit charge
Owner_ /�/1 ,c �j� � Connection fee_����SC_ _
k. _ Paid by�� __ V
Type of building LA). Date connectedY_ TO
Service rate Inspection fee /D °
Contractor Paid by Date __._,--..--
Size of connection � Assessment Paid
PERMIT TO CONNECT ��' ,a '
Tigard Sanitary District
PERMIT N° l 7 r PATE
PERMIT 19 GIVEN 'rc
OF
TO CONNECT A.
TO TIIF SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERM?r MT1ST BF POSTED ON THE DESCRIBED PREMISES T?NTIL CON-
NECTION If MADE ANu INSPECTION OF CONNECTION HAS BEEN COM-
PLETED,
PERMIT FEE PAID �....` ; ,,,,,,, TICARD SANITARY DISTRICT
CONNECTION INSPECTED AND APPROVED
Date Superintendent