11865 SW TIGARD STREET 1.1865 SW TIGARD S"WT
I
N
.b
N
ro
a
H
3
1O
I
Address �.5' Permit Nr; 7�
Permit charge,
Owner � ;�� Connection fee
Paid by,
Type of building^—&L Date connected
Service rate Inspection fee
..�.-
'ontraetor i Paid by__ Date
Size of connection `' Assessment Paid
1
N�
l TO CONNECT
jard Sanitary District
PERMIT V 1374 DATA cam'
PE;'MIT IS GIVEN To
OF
TO CONNECT A
TO THE SYSTEM OF TIGAiRD SANITARY DISTRICT
AT z . _ -(p f'
b THIS PERMIT MUST Rr, POSTISD ON THE DESCRIBED PREMISES UNTIL CON
NECI'ION IS MADE AND INSPECTION OF CONNECTION HAS BEEN C91M-
PLETED.
PERMIT FEE PAIDa.... (..,:.................TIGARD SANITARY DISTRICT
��.....n..�,..ww
CONNECTION INSPECTED AND APPROVED
Date - Superintendent -
—��