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Addreja//l9S�.S— Penrit No.il 2.
Name of Occimant Permit charge 2 C `d" 7 I
Connection fee
Paid by
Date connected` _
Type of Building Inspection fee
Service Rate, Paid 5y ___—_Date _
Contractor _ _ Assenment ____—Paid_��
Size of connection
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PERMIT TO CONNECT
Tigard Sanitary District
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PERMIT �J�:' ��.2 DATE --- "-''--------
PERMIT 1S GIVEN TO / I cam- y
OF
TO CONNECT A_ y b /*/, r r /
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST HE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NE(l'H)N 13 MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLE1'ED.
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PERMIT VEE PAID $--&j.............................TIGARD 43A#11lr&W DISTRICT
Rv ' -74
CONNECTION INSPECTED AND APPROVED
0. 0-0
Date 3uPerintendent