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13265 SW ASH DRIVE
PERMIT TO (;GNNECT
Tigard Sailifary Dishic i
PERMIT 9 7 s DATE
PERMIT IS GIVEN TO
OF r.
TO CONNECT A y �
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MIDST BE POSTED ON THE DESCRIBED PREMISES UN' CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN ;;'OM-
PLETED.
PERMIT FEE PAID ..: ................I............TIGARD SANITARY DISTRICT
By
CONNEC'TIC N INSI'ECTED .AND APPROVED
bate Supe endent_
i
ANdrese / -�-�'�-5" S l/V _ S</ Ari L'c Permit No.
7fz&
Name of Occupant ��i►.c'fc�f'- Permit charge m`_
Connection fee 'Ce .5
Paid by J"�•sE/fl �c��� E
Date connected
Type of Building ?15'PeE.4-ICE- Inspection fee /0 )
Service Rated ¢
Paid by TLS to4o<yEr- Date -z.ter rs
Contractor_T C�e4 A y C/,C„ Assegmeat Paid _
Size of connection w
1