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PERKLIT TO CONNECT C 1",
Tigard Sani.t.--ry District 3�ra6
PERMIT N0 1447' DATE
PERMIT IS GIVEN TO
OF
TO CONNECT A f
T•J THE SYSTGIM OF TIGARD SANITARY DISTRICT ^�
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPE'.'TION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $R ... .,....................--...TIGARD SANITARY DISTRICT
BY-- - ----- A_.. --
- ---- - - - - - --- - --- - -
CONNECTION INSPECTED AND APPROVED +I
it
I)Rte Superintendent --
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Address 12760 S.W. 128th Permit No. 1447.
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Permit charge,_..__._
Owner iG, .� 7x�e. .d. ,�� dclC�zz Connection fee_ 375.00
Paid by
Type of building_____, Res. Date connected
Service rate Inspection fee_ 25.00
Contractor Dale Construction Paid by Dai.e
Size of connection 4" Assessment Paid