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9210 SW CENTER STREET
Address_ Permit No. / _1,7
Permit charge
Owner _ Connection
Paid by
Type of Building Date connected
Service Rate Inspection fee
Contractor _'�51� 10 Paid by .--.—Date
Size of connection Assessment Paid
PERMIT TO CONNECT
Tigard Sanitary District
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PERMIT NU 1217 DATE'�_a
PERMIT IS GIVEN TO + � _ C
OF
TO CONNECT A -f �
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID '.l.-.�.��l�.Q...,'...�_fTIGARD SANITARY DISTRICT
By
Y/
2.
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CONNECIrION INSPECTED AND APPROVED
Date Superintendent