12320 SW 127TH AVENUE-1 12320 SW 12, TH AVENUE
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PERMIT TO CONNECT AK
Tigard Sanitary District 3Q4�
PERMIT N? 14 4 6 DATE
rFRMIT IS GIVEN
OF ----
TO CONNECT A --� —___-- -_— -.--TO TNF SYSTEM OF TIGARD SANITARY DISTRICT
AT ---- -- _.— — __.------- --- --THIS PERMIT MUST RE POSTED ON THE DFSCRIB,ED PREMISES UNTIL,CON-
NECTION IS MADE AND Ir:VECTION OF' CONNECTION HAS BEEN COM-
PLETED.
PFF.MIT FEE PAID $...... .......:. .................TIGARD SANITARY DISTRICT
BY ..
CONNECTION INSPECTED AND APPROVED
— llHie Superintendent �,
Addr-ess 12320 S.W. 127th Permit No. 1446 -
Permit charge.__
Owner __ Connection fee 375.00 r
Paid by
Type of building Res . Date connected_____
Service rate Inspection fee 25.00
Contractor Dale Construction Paid by Dale 'Jonst. Date_
Size of connection 4" Assessment Paid________