12655 SW 128TH AVENUE w
12655 SW 128`H AVENUE
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Address ��l,S . ;��{ %, cc/ Permit No.
Permit charge__ V elv
owner ��,, �c�a,a,•n Connection fee_
Paid by_
type of Building nate -onnect•.ed
Service Rate ' Inspection fee /G,
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.ontractor _ F Ad by Date
;ize of connection Assessment Paid
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PERMIT TO CONNECT
Tigard Sanitary District N\6!�
PERMIT N? 120 DATE 2
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTE'4 OF TIGARD SANITARY DISTRICT
AT
I HIS PERM ' MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CO3-
NEcTION IS MADE AND INSPECTION OF C',NNECTION HAS BEEN COM-
I y,ETED.
PERMIT FEE PAID $
. . ......... ...TIGARD SANITARY D'STRICT
X
BY
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0
C,)NNECTION INSPECTED AND APPROVED
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