12265 SW HALL BLVD 4
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12265 SW HALL BOULEVIRD
PERMIT To CONNECT
Tigard Sanitary District
PERMIT N9 12010
PF.R1111ir IS GIVEN TO
Or
rO CONNECT A
W THE SYSTEM OF TIGARD 4ANITART DISTRICT
/ T
THIS PERMIT MUST BE PO,3TED ON TIRV DF9CRIBFD PREMISES UNTIL CON-
NFCTION IS MADE AND INSPECTION OF CONNFc,riON P-,S BEEN Com..
PLATED,
PERMIT FEE PAID $
. ..................-TIGARD SANITARY D14TRICT
By
CONNECTION INSPECTED AND APPROVF.,)
G ` Permit No.
Address 1_____�=�1
Permit charge d2 °`
Owner " .Qr ,��,�.� Co:Anection fee
L91,11 Paid by
Type of Building ,Ic connected
Service Rate Inspectioii fee ID
Contractor ;paid by Date
Size of connection �{ Assessment Paid
Addrea/�,�(p JO tCZ Permit No. 1.
Name of OccupantPermit charge
�e
Paid
Date connected
Tvpe of Building L8= L , __ I»gpection
Service Rate_ 9. c `� Paid by ___.Date
Contractor_ Aeeewment 3 to� -.Paid V rc y '� a
Size of connection .