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i23�6 SW 127TH AVFNUE
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PERMIT TO CONNECT
Tigard Sanitary District
6
PERMIT N? 1249 DATE
PERMIT IS GIVEN TO , ��- --�--
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT 2 .� YS+ ,� �r /'i
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISI S UNTIL CON-
NECTION IS MADE AND INSPECTION OF CON.IIECTION HAS BEEN COM-
PLETED.
PERMIT FEE P.11b �...!�.- ....,,,TIf', .3ANITARX DISTRICT
CONNEC^'ION INSPECTED AND APPROVED
Date - -- 3upertntenrlrat
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Addressa Permit No.
ia2 yr
._ ' .'"" •�-4-�-�--Q- Permit charge
owner l
_ Connection fee__—���,�c
Paid by
Type of Building Date connected _ g -_,��2-0,3 ,
Service Rate Inspection fee_/n Ole'
Contractor. Paid by______ Date
Size of connection �
Assessment Paid
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