11959 SW PACIFIC HIGHWAY 11959 SW PACIFIC HIGHWAY
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT Ntt 752 DATE���._—�_L�L! 4
PERMIT IS GIVEN TO —�G:�/ S -)RIV 17-8 y ���1�4—vicy
OF (135 _ VIS k_ - fclgli-PevpREfiGi✓
TO CONNECT A t +• AT AAL ___--
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION I9 MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $..,.IF..........................
CONNECTION INSPECTED AND APPROVED
Date Superintendent
Address U Permit No.
Name of Occupant Permit charge
Connection fee
- --._.. __ — ----- Paid by
Date connected
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Type of BuildingL"dat4Inspection fee---
Service RatePaid by Date�_
Contractor ----------- - _ Assessment -- _ _Paid
Size of connection