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PERMIT TC cbNlgEC.L
Tigard Sanitary District
:PERMIT NO 631. DATE
"FR3151' IS GIVEN TO F
OF ?:,✓ +.e a. Se _l.�'1/jam_
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
4 1!
AT
THIS PERMIT MUST RX POSTED O'; ^IZ UZSCRIBED PRFMISES UVUL CON-
NECTION IS MADE ANS' INSPEt TION (}F CONNECTION HAS BEir.T" COM-
PLETED.
PERMIT FEIN: PAID $...................................TIGARD SANITARIA!'STRICT
By
CONNECTION INSPECTED AND APPROVED
Date 96perintendent
_� � 3 !
Addreee_��5 _ , ''. 1✓� 1 Permit Nn
1
�� C Permit charge � .�0_ . 2 �►�
Name of Occupant �. �
SCL1 .�u^)c Paid by
_ Date connected _
Type of Building __ __ _ Inspection fee
Service Rate __ Paid by
Contractor Assessment 3 FAV Paid jtj
Size of connection _-
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