11775 SW WARNER AVENUE 11775 SW WA-RNER AVENUE
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PERMIT. TO ,CONNECT
Tigara S=i itary-District
PERMIT N9 696 1)ATE
PERMIT is GIVEN TO
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
THIS PERMIT MUST BE POSTED ON THE DF9CRIDE'D PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS B7N COM-
FLEED. e-7--
PE%MlT FEE PAID .........................T T
By
A lye
CONNECTION INSPECTED AND APPROVED
Date Supe4intendent
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Address/�,� � � ��,�� Pe--mit No.
Name of Occupant Permit charge0
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Paid by.
-------- ------------ Date connected
Type of Building___(� �244L Inspection fee
Service Hatet(� Paid by --Date
Contractor Assessment 4 3 ,. C)O-Paid
tCC.C�LF'��lk�.'7.�A�/�/4L�(� f'rf�1A � 3/j9�Y
Size of connection
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