11468 SW TIGARD STREET 11468 SW TIGARD SSi WX
I
u
b
N
ro
on
H
3
s
1
a
Add ress�f4G� ` _ Permit No. �4 0�
Permit charge ,2
Owner-� r -,-%2 _ Connection fee��'y
Paid by
Type of f3uildin�; __ Date connected _
Service Rate__ Inspection fee__"
Contractor _ Paid by Date
Size of connection _'' `y Assessment Paid
PERMTT TO CONNECT
A
Tigard Sanitary District
PERMIT N? 1 6f,
PERMIT IS GIVEN TO
OF
TO CONNECT A
.-------- .._— -
TO
---------
TO THE SYSTEM OFTIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIIIED PREMISES UNTIL CON-
NEMON IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERmur FEE PAIDS 43
........._...TIC ARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
Date Superintendent