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CONNECT
City of Tigard
PermitN.o 862 DATE
PERMIT 15 GIVEN TO__--�-' t'-'��--•- �,,r
OF_0.1
TO CONNECT A
TO THE SYSTEM OF CITY OF TIGARD
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AT _I l_L, -- ._ �._ • I
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS WDE AND INSPECTION Or CONNECTION HAS BEEN COMPLETED.
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PERMIT FEE PAID CITY OF TIGARD
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By, -
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CONNECTION INSPECTED AND APPROVED } y
Date
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Address. // Permit No.
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Name of Occupant Permit charge 2 - —
Connection fee
-- -- - Paid by ---
Date connected
Type of Building -- _ Inspection fee
Service Rate Paid by - Date
Contractor __------- Assessment Paid
Size of connacti.on
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