SWR1969-1169 PERMIT TO CONNECT _
Tigard Sanitary District
PERMIT No 1169 DATE 7 -
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PERMIT IS GIVEN TO
OF:
TO CONNECT
/I - - 0 - -
TO THE SYSTEM OF TIGARD .SANITARY DISTRICT'
T •
.
THIS PERMIT MUST BE POSTED ON THE DESCRI(ED,PREMISES UNTIE, CON.
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN CCiM'-
PLETED.
PERMIT FEE .PAID t 7 0 TIGARD 'SANITARY DISTRICT
(>efr ?: B Y A
A.4
CONNECTION INSPECTED AND APPROVED
•
Date Superintendent
Address r� KA Ei. = c T, Permit No; / ' ? � � / �F,
i S 6. 4 t_4. P G. t - Permit charge _, ' m--t
0
' Owner Connection fee • Q� 7,a�"(� �- -
Paid by
•
Type of Bui1 )AI t r 4 P7 Date connected
o GP
Service Rate Inspection fee / 0
Contractor Paid by Date
Size of connection Assessment Paid