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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° LATE
PERMIT IS GIVEN TO
OF -- ----
TO CONNECT -----
1 O'l HE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERM IT MUST HE POSTED ON THE DESCRIBED PREMISES UNTIL C08-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID S_ .......:...................TIGARD SANITARY DISTRICT
By
CONNEC"CION INSPECTED AND APPROVED
1
1
Date
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1
Add res,s 1167C' S,,W 116th _ _.. Permit No. 1392
Permit charge,..._....__._
Owner Dale .S19 a.S�1d� .igt2 ntsa.c.to�� T. Connection fee...___3a;'Qp---------.
Paid by
Type of building _ _ Date connec ted__."_t_ _�
Service rate Inspection f=e 25.00
Contractor Dai a Congtrjjr.
.tinn Paid by PatE!
Size of connection _ " r Assesament–_^,—_ _Pb d_`N��
Start billing 1st of August