13240 SW VILLAGE GLENN DRIVE I__iZ4U W 'J1 LLA( :; GLENN
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F1ddressjPermit No.,�_?j _
Permit cliarge
:)wner — `i Connection fee d%�
Paid by—i _.
type of Building '� Date connected 4 /— S .?
Service Rate— In!soection fee�/�_"" _
-ontractor 'aid by_ F __Date
Size of connection Assessment Paid
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 1.171 DATE
PERMIT IS GIVEN TO _
OF
'i O CONNECT A __. --- ---- --- ----- —
TO THE SYSTE"T OF TIGARU '+ANITARY DISTRICT
Al' —
TIIIS PEh`;IN MUST RE POSTED ON THE DI.SCIIIBED PREMISES UNTIL CON-
NECTION VS MADE AND INSPECTION OF C CINNECTION HAS BEEN COM-
PLETED.
rr .'141T FEE PAID $..... ............................TIGARD SANITARY DISTRICT
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CI?iVNFCTION INSPECTED AND APPROVED
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