12605 SW 124TH AVENUE r�
_ 126U5 SW 124TH AVENUE --
PERMTT ' CONNFC 1,' ' `
Tigard Sanitary District lvsya
PERMIT Ivo 1440 DATE � --'/' -7/
PFR1111T GS GIVEN TO
OF
TO CONNECT A
TO THE SYSS EM OF TIGARD SANITAhY DISTRICT
AT
THIS PERMIT MUST RE POSTEb ON THE DESCRIBE fj PRUN".jES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION IIAS BEEN COM-
PLETED.
PERMIT 1''EE PAID $.... ........ ..................rlGARID SANITARY DIF TRICT
_By
)NNECTION INSPLCTED AND APPROVED
Date ti,ir e,Inirn is ni
t
1
I
I
I
i
`'DYU
Address Permit No. j qqO
Permit chargee
Owner v Correction fee
i'ai d by_._____,_____
Type of 1,uilding �aj Datq connected
Service rate Inspection fee_ -1`��`'
Contractor L els• Paid by_ Date
Size of connection ��' Assassment i_ Paid _
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