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12020 SW Nd.NZANITA :HURT
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Address '1 t"� Gd /�1a _ Permit No. � y _
Permit charge
Owner Connection fee
--- Paid by, ,eI-,I
Type of Building Date connected
Service Rate Inspection fee '
Paid by ateContractor - f , /,ELa
Size of connection /J
AssessmentPaid
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N? 1124 DATE —
PERMIT
ATE -PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT '~
AT
THIS PERMIT MUST RPi POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NF,CTION IS MADE AND INSPECTION OF CONNECTION HAS REF- COM-
PLETED.
PERMIT FEE PAID a.. ............................TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
Date Supertx►tendcmt-- -T