11620 11622 SW LOMITA AVENUE 11620 & 11622 SW LOMITA AVENUE
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Address �/`_��� �2 S �U l ol-21 r/J Permit No. /W7
Nat a of Occupant /`7�N�' 1y, ���is Permit charge ,2
Connection fee ✓`D A.o a
Paid by_! sf e lt'L n C-
_ Date connected
Type of Building� 01 Inspection fee
Service Ratea Paid by N,�./(Cec.C' Dat® /�'/n
Contractor--__ C �Cvc JQ�� Assessment __.______Paid
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Size of connection _�f
PERMIT TO CONNECT
Tigard Sanitary District
HERMIT N° 747 DATE( W&�k Al lG '
PF.RDiI^T IS GIVEN TO'��--; i(tr'
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST HE POSTED ON THE DESCRIBED PREMISES UNTIL,CON-
NECTION IS MADE AND !NSPECTION OF CONNECTION HAS BEEN COM-
PLF,TEB;
PERMIT FEE PAID $- ............................TIGA b, TARY DISTRICT
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C 1i R
__
CONNECTION INSPECTED AND APPROVED
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