13495 SW VILLAGE GLENN DRIVE 13495 SW VILLAGE GLENN DRIVE
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'address-1�.tic `� l �, Permit No., ,,
Permit charge_
)wner— Connection fee
Paid by
Date connected
'ype of building y.
service Rate inspection fee
'ont.ractor _ _ Paid by –` Date
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size of. connection � Assessment ,Y _« Paid
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PERMIT TO CONNECT
Tigard Sanitary D.7 atrict
PERMIT N° 115 2 DATE
PERMIT IS GIVEN TO --_ ---��
OF
TO CONNECT A ----
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PL'1,,'ED.
PERMIT FEE PAID .. _.............................TIGA*P SANITARY DISTRICT
By _; e
� .,,.�� .rMMi•N/V�MMiAA
CONNECTION INSPECTED AND APPROVED