13500 SW VILLAGE GLENN DRIVE 13500 SW VILLAGE GLENN DRIVE
PEP.MTT TO CONNECT 3�J
Tigard Sanitary Di.(Arict
PERMIT N° 1232 DA'lX
PERMIT IS GIVEN TO _, L:66'- �', --,«`" �• -- --�_
OF
TO CONNECTTO THE SYSTEM OF TIGARD SANPCARY DISTRICT
AT
THIS PERMIT MUST RE POSTED ON IE DESCRIBED PREMISES UNTIL.CON-
NECTION 19 MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAIL) $.....:a:..�. ...._...........TIGARD!9 MTARY DISTRICT
-�°-�
By
- f00
CONNECTION INSPECTED AND APPROVED
- --- —
Date 86perintendeet
,w
4ddress Permit No.
Permit charge
(
)wner__ � Connection fee
Paid by
type of Building! ] Date connected
Service Rate '� Inspection fee /r
:ontractor Paid by Date
Size of connection -/�� Assessment Paid