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Address Permit Noe
Permit charF,s__r___—�
Owner Connection fee �7
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Type of building Date connected—
Service rate Inspection fee_
Contractor Paid
Size of connection, Assessment Pa.i.-
]HERMIT TO CONNECT
Tigard 11.3,an tary District
PERMIT N�) 1368
PERMIT IS GIVEN TO -bl mi. -____.--.-.----.- --
TO C011'NFCT A _I_ -------- ---- _---
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT / .1-( +1' .i -AA0 ---
THIS PERMIT MI19T BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION 114 MADE AND INSPECTION OF CONNECTION HAS BEF'I COM-
PLETED.
PERMIT FEE PAID ... ::l.. . ..........TIGARD SANITARY DISTRICT
wy B7
CONNECTION INSPECTED ANIS APPPOVED
Date Supaintenden��--