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Address_ ,� '7 7 :� � tlhr�sl_Y _ Permit No.
Permit charge ;2
Owner Connection fee
Paid by
Type of BuildingDate connected
Service Rate _ Inspection fee!`__
Contractor Maid by
Size of. connection Asses:,ment -.---Paid _
PERMIT TO 'ONNECT
Tigard Sanitary District � i► bl�,
PERMIT M 1262 DATE i- .l e16
PERMIT LS GIVEN TO �/�/
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TO CON19ECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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Tum PERMIT ;MUST RE POSTETI ON THE DESCRIBED PREMISES UNTIL CON-
NECTION 1S MADE AND INSPECTION OF CONNECTION IIAS BEEN COM-
PLETED,
PERMIT FEE PAID ;-.., . ;' ..� s......TIGARDSiVNITARYDIRT CT
By
CONNECTION INSPECTED AND APPROVED
Date Superintendent