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Audress___`�_�+Lf� off./�:�i�,�/ /li C��` Permit No. ��
Name of OccupantA/�Se-.t/ Permit charge
-- Connect.on {ee
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-- -- _ Paid by .. /ri ll� /�'c-/*--
- — Date connected
Type of Building1 k9�
Inspection
Service Rate ?
-- � el)c') Paid by �
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Contractor- r
Assesoment_____ Paid _
Size of connection
PERMIT TO CONNECT
City of Tigard
Permit N1,) DATE
DATE
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PERMIT 18 GIVEN
TO CONNECT A
TO THE SYSTEM OF CITY OF TIGAROAT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID $ CITY OF TICARD
By-
CONNPCTION INSPECTED AND APPROVED
D"+° Superintendent
1