11765 SW KATHERINE STREET w eTAr r w r
1.1765 SW KATHERINE S'T'REET
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PERMIT TO CONNECT
City of Tigard
Permit N° 80 4 r
PER,'.! IS GIVEN TO_-_ 4/4) 5___ _ Xa •__ _ ___.�_
OF 4r
TO CONNECT A
TO THE SYSTEM OF CITY OF TIGARD i
y � f
AT
THIS FFRMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
IERMIY FEE PAID $ .CITY OF TIGARD
A
CONNECTION INSPECTED AND APPROVED
Superintendent
Address A;�IAIC�"A 'e- Permit No.-- Y-42
Name of Oc ;upant Permit charge
Connection fee
Paid by
Date connected --li-113 I
Type of buildiLiq L Inspection fee
31.1
service Rate e Paid by Date
Contractor ic- A:;sessmeni
Size of coni.ection 42/-