12395 SW 127TH AVENUE ® 1
12.395 SW 127TH AVENUE
s
x
L
n
('V
Ln
al
l"1
OldN
;� �' 1!/ SAF' sR' � � f•
PER AT TO CONNECT �n
kl l 7
Tigard Sanitary District
PERMIT N9 '_N9 ( DA'rE
HERMIT IS GIVEN TO
OF
Tu CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT^THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NF.C,PION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $... '�,., 1. e" ....TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
-- —Date `- - - — Superintendent
I
I
Address A3 S Permit No.
Permit charge
Owner Connection fee
Paid by
Type of building � ,Lv, Date connected_ /" 2-/7-7p
Service rate -:15 Inspection fee /D
Contractor Paid by Date
Size of connection `T �/ Assessment Paid