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13195 SW ASH DRIVE
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Add es:; 3115 SLjG�c�,. Permit No. ///W/
Permit charge _av
Owner__ Connection fee 5 0
Paid by_ j.�
Type of Building Date connected
Service Rate Inspection fere
Contractor����� � Paid by_JDates
Size of connection_ " _ Assessments_ Paid
PERMIT TO CONNECT
Tigard Sa rl itary District
PERMIT NU 1116 DATE
PERRIIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DIn;RICT
AT
THIS PERMIT MUST BF. POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $ . . ....... ...... ...........TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
Date Superintendent
L