11555 SW TIGARD STREET 11555 SW TIGARD MMMT QQr•
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PERMIT TO CONNECT
Tigard Sanitary ]District X05
PERMIT N9 1.391 i/ArIV
PER311T 1S GIVEN TO
OF
TO CONNECT A I
TO THE SYSTEM OF TIGARD SANITARY DISTRICTv
AT
THIS PERMIT MUST BE POSTED ON THE I)ESCRIBED PRISMISE8 'JNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEF, PAID I............... ...................TIGARD SANITARY DISTRICT
CONNECTION !INSPECTED AND AT PROVED
i
Date $uperintendent
Address_&,i
Permit charp,P
Owner Connection`- � �' y,�
'��c Connection fee b"
Paj.d by _
Type of building _
Date conneo ted7/
Service rate _ Inspection fee °
Contractor Paid by�_
Dal
Size of connection AssEssment_--
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