11645 SW TIGARD DRIVE 11645 SW TIGARD 914t@WT �� __
PERMIT TO CONNECT
Tigard Sanitary District
PERMITN9 11 S3 LATEi -_�`
112MMIT IS GIVEN TO ( ��.+ +-^ ye ►'=� " � L. �--••
Or
TO CONNECT A.--��------ -- -- —��� _---TO THIS SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST nE F08T ON THE DESCRIBED PREMISEti UNTIL.CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED. CC
PERMIT FEE PAID $Za. ..-.........TIGARD SANITARY DIVARICT
� fir..... -.�
CONNECTION INSPECTED ANT! APPROVED
Date gipWfij ndent-Y__--
---- ------- -----
1`
Addressn
O/L 4s`�..�,f��„� Permit No. P3 -
(/ Permit charge_a —
Owner� "� "' � - Connection fee 1-410 —
Paid
s0 --Paid by _--
Type of Building A2410 — Date connected_ y yo -Cof_ --�
Service Rate _ Inspection fee_let
— —_
Contractor_ _-` Paid by Date
Size of connection Assessment Paid