14400 SW 92ND AVENUE-1 14400 5W 92NO AVENUE —
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Permit charge 7-
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Owner Connection fee ,n; ,.rO
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Type of Buiiding Date conneC.L2d
Service Rate Inspection fee / 0
Contractor_aE_ Paid by__ _Date
Size of connection � — Assessment _Paid`
PERMIT TO CONNECT
Tigard Saha ittary District
PERMIT N9 1,162
S
1'111311T IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
A'1 ,
THIS PERMIT MUST HE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FSE PAID .. . .........._....-.........TIGARD SANITARY DISTRICT
I
By
CONNECTION INSPECTED AND APPROVED
Date Superintendent