12555 SW 128TH AVENUE-1 sw :.28TH AVENUE
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Address Permit No. /305
44 Permit charge 2
Owner Cc :necticn fee
*'aid by
Typ( of Building c�,. Date connected "255-.2,7e
Service Rate r7 inspection fee /Z�
Contractor Paid by DW-e
Size of connection Assessment_ Faid
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PERMIT TO CONNECT
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Tigard Sanitary District
PERMIT lit° 13 P 5 DATE • It' �*
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PERMIT IS GIVEN TO
OF
TO CONNECT A
1 TO THE SYSTEM OF TIGARD SANITARY DISTRICT —� —
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLYTED.
PERMIT FEE PAID j..... ..�....f�.............TIGARD SANITART DISTRICT
By
I
CONNECTION INSPECTED FiND APPROVED
Date Superintendent