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14500 SW 92ND AVENUE —
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Permit Foo_.
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Permit charge
Connection fee
Owner
Paid by
Type of building Date connected
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Service rate_ �%oA-V0_ Inspection fee
Contractor_ Paid by _.Dat''_.__ _._. _ ..._
A s s e s sme n t_,____�,,,__Pa�.d
Size o f connection- __�_�__ -_w-__
PERMIT TO CONNECT ,
Tigard Sanitary District
PERMIT Ntl 13(-1,7 DATE -
PERMIT IS GIVEN TO _ �1[.�t� /yt•Ei � ____
OF ,.
TO CONNECT A
TO THE SYSTEM OF TIGA"D SANITART DISTUICT
AT
THIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED. )) /
PERMIT FEE PAID .......TIGARD SANITARY DISTRICT
By
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CONNECTION INSPk:(" ED AND APPROVED
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