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Name of Occupant Permit charge
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Type of BuildiwvC4
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PERMIT TO CONNECT
Tigard Sanitary Di lstrict
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PERMIT N9 670 DATE
PERMIT IS GIVEN TO ___
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DFACRIBED PREMISES UNTIL.CON-
N1EC'"ON IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
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PERMIT FEE PAID $....................................TIGARD SANITARY DISTRICT
CONNECTION INSPECTED AND APPROVED
`__—_ Date— Si ntPtwent