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PERMIT TO CONNECT �'�✓
7 ,5-
Tigard Sanitary District
PERMIT V 1361 DATIt �G'_-?
PERMIT IS GIVEN TO
OF
TO CONNECT ATO THE TILE SYSTEM OF TIGARD SANITARY DJ9TnICT
AT
THIS PERMIT MUST BE POSTED ON TILE I)FSCItIBFD PREMISES UNTIL,CON-
NECTION IS MADE. AND INSPECTION OF CONNECTION HAS BEEN COY(-
PLETED.
PERMIT FEE PAID f... .. ..�...� .......TIGARD SANITARY D 7BIC
CONNECTION INSPECTED AND APPROVED
11
Address ' C'( ,; . � , Permit
N o o _•.�f..'��'..�.
�r Permit charge__ _
owner ,i� _d�� �ts�«. c��f. << � _ _ Connection feer_____„!7�"
Paid by •---..�., �_ ._ __
Type of building, [ ',•J, Date connected—
Service
onnectedService rate Inspection fee
Contractor _. Paid by
Size of :;onnection Asso9sment Paid
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