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Address / 31 a,vt, Permit iJo. /,/4
Permit charge 1'
Owner w Con,iection fee ���"'
-- Paid by
Type of Buiiding Date connected
Service Rate` Tns�ection fee n`'Z)
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Contractor -- Paid b ' Date
Size of connection Assessment Paid
PERMIT TO CONNECT
�g. Tigard Sanitary District
PERMIT No 1. DATE
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIG,ARD gANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRII2ED PREMISES UNTIL CON-
NECTION 1S MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PEKMIT FEE PAID $....................................TIGARD SANITARY DISTRICT
BS
CONNECTION INSPECTED AND P.11PROVED
Urate Y Superintendeut
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