10170 SW KATHERINE STREET 10170 SW KATHERI14E STREET
I
u
v
G
L�
41
1J
C7
n
O
I
WjLw r .
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N? 12 6 q DATE VL
�
PERMIT IS GIVEN TO CO14C
OF
TO CONNECT A '
TO'i HE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DFSCRIBED PREMISES U.TTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PFAMIT FEE PAID $........!!Z.. �. ..........TIGARD SANITARY DISTRICT
By
.i,
CONNECTION INSPECTED AND APPROVED
Date Superintendent
l
Address / / ' Permi t No
Permit charge
�aner //,-z.>� �' ��Y Connection fee
Paid by
Type of Building .c,� /� 04�- . nate connect.: d
Service Rate`_ Insper_tion fee /�,�`L}
Contractor Paid by Date
Size of ccinection Assessment Paid