11795 SW KATHERINE STREET 11795 SW KATHERINE STREET
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PERMIT TO CONNECT
TigcLj:d Sanitary Districtjo� ?2-
PERMIT N? 1254 DATE
PERMIT 'AS GIVEN TO
OF
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TO CONNECT A
TO THE RYSTEM OF TIGARD SANITARY DISTRiCjk
AT 90Yw
THIS PERMIT MUST BE PCSTED ON THE DR-SCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION nF CW"OUCTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $....r ...........�..............TIGARD SANITARY DISTRICT
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CONNECTION INSP:XTED AND APPROVED
Date Superintendent
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Address ��`> Permit No.
Permit charged cAsJ
Owner ,z._ �, ��. Connection fee 2 <r, tee '
Paid by
Type of Building/ Date connected
Service Rate, Inspection fee__ /D�P�
Contractor_ _ Paid by` Dater
Size of connection Y ' _�_ Assessment`_ —_Paid