11615 SW TIGARD STREET 11615 SW TIGARD S `1'
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PERMIT TO CONNECT
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PERMIT N9 I V764 DATE - - --
FEItMIT IS CIVEN ---
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERM,T MUST BE POSTED ON THE DESCRIBED PREMISES UNTO,CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN �00M-
PLETED.
PERMIT FEE PAID ¢.. _ ...............TIGARD SANITARY DISTRICT
By
N A J
1
CONNECTION INSPECTED AND APPROVED
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Permit charge
Connection fee .zSCa
Paid by
Type of Building — Date connected��- 'Z�=��'
Service Rate , Inspection fee /D —
Contractor_ _—_�_ _�_ Paid by—^: !Date
Paid
S. ze of connection_�L �' ___�_ Assessment` _ _`