12360 SW 127TH AVENUE 12360 SW 127TH AVENUE
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PERMIT TO CONNECT
3Yw 6
Tigard Sanitary DistriCt
PER.iv.I;IT N? 1445 DATE
PERMIT IS GIVEN TO
OF
TO COWNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
Tins PURMIT MUST BE POSTED ON THE DESCRIBED !REMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED,
PERMIT FEE PAID $ . . ........................ .TIGARD SANITARY DISTRICT
—By -
A�rv.
C ONNECTUIN INSPECTED AND APPROVED
Dale Superintendent
Address 11360 S.W. 127th Permit No. 1445 .
Permit charge
Owner Connectjon fee 375.00
Paid by
Type of building_ Res. Date connected
Service rate Inspection fee _25.00
Contractor Dale Construction Paid by Dale Const, Date
Size of connection 4" Assessment Paid
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