9165 SW INEZ STREET-1 9165 SW INEZ STREET
1
Address Permit No. �/�d _.
Permit charge
Connection fee
Owner fS
Paid by.____.___
Type of building - Date connected
Service rate Inspection fee _: `
Contractor _ ,_ Paid by Date..
Size of connection `�� Assessment Paid
PERMIT TO CONNECT
Tigard. Sanitary District
PERMIT N9 141. 8 DATE -
I'FI1J11T IS (:IVVN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
THIS PERMIT MIJ.3T BE POSTLD ON Til DESCRIBED PREMISES i1NTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
Pitn%-19' WEE PAID =....._.,;r...: .......TIGARD SANITARY DISTRICT
l f
By
CONNECTION INSPECTED AND APPROVED
- -
Date - —-- — - ------Superintendent_---