13560 SW VILLAGE GLENN DRIVE 135tiU ,:,W Vit JAGE GL,i':NN DRIVE,
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PERMIT TO CONNECT a�
Tigard Sanitary District
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PERMIT N° 1257 DATE _?%' �nb, (,I _
I'I:RMIT IS '-IVEN TO
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TO CONNECT A y //
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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THIS PERMIT MI1ST BE POSTED ON TI!E DERCRIBED PREMISES UNTIL CON-
NEC'rION 1S MADE AND INSPECTION OF CONNECTION HAS BEEN COIN.
PLETED.
PERMIT FI'E PAID
�1•••�-•................TIGARD SANITARY DISTRICT
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COP ,SECTION INSPECTED AND APPROVED
Date
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tin
Address `� `~ �'� ^,f Permit No.
( Permit charge
Owner / / J Connection feeY,_
Pa i d by__
Type of building Date connected
Service rate �(,co..t,� Inspection fee_
Contractor Paid by Date
Size of connection f Assessment Paid