12265 SW 127TH AVENUE 12265 SW 127TH AVENUE
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PERMIT TO 00NNECT
Tigard San:;.tary District
PERMIT N9 1601 DATE
PERMIT IS GIVEN TO
OF
TO CONNECT A d
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NFCTION IS MADE AND INSPECTION OF CONNF,CTION HAS BEEN COM-
PLYTED.
PERMIT rEF PAID $ . ..... _.........TIGARD SANITARY DISTRICT
BY
1
CONN0r'rION INSPECTED AND APPROVFD I
Date _.—
NNW e r
I
i
Address 12265 S.W. 127th Permit No. 1609
Permit charge
Owner Mr. & Mrs. Frank K. Koch Connection fee 400.00
Paid by Da].e._.=jj ction _..�
Type of building Residence Date connected4-25-72
Service rate 3.00 per month Inspection fee_ 200
Contractor Pale Construction Paid by Dale Const Date 3-21-7.
Size of connection li�� Assessment Pal d�__`