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Address /. '" �' / a.kA� Permit No.
Permit
Owner �� �s � � ,iy ,, t Connection fee_,,_.1
_ Paid by_, _
Type of building Vic, Date cjnnected� �? � G Gg,�
Service rate _ Inspection fee, 0
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a of connection �/�= Assessment— JaJ.d___
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PERMIT TO CONNECT ;��
Tigard Sanitary District 4 '��.3,/
PERMIT NO 1271 DATE
PERMIT IS rrlVEh :v
Af
OF
TO CONNECT A
TO THE STSTEM OF T!GARD SANITART DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION V4 YADE AND INSPECTION OF CONNECTION IIAS BEEN Com-
PLETED.
PERMIT FEE PAID ;.....f.. �. ..............TIG"'..D SANITABT DISTRICT
CONNECTION INSPECTED AND APPROVED
Date Superintendent
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