12705 SW PACIFIC HIGHWAY 12705 SW PACIFIC HIGHWAY
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PERMIT TO CONNECT
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City of Tigard
PermitN.o / / Al
r�(I(j DATE
PERMIT 15 GIVEN TO
OF-
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70 CONNECT A _ ------
TO THE SYSTEM OF CITY OF TIGARD
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBF'D PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID S _ _{� .__CITY OF TIGA J/,r
/0 /►7 BY - --
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CONNECTION INSPECTED AND APPROVED
Dale Superintendent
Address .---1,.r'1l14 IN �IiS�li/., /!� V mit No.
Name of Occupant Permit charge
Connection fee
--- ---- — _—. Paid by—.-- .22-e7-=�R
Date connected
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Type of Building ., !i/f/c'e, �eld9 _ Inspection fee 'y r r'
Service Rate Paidl i.r�;c 'i a`►.Date
Contractor Assessment Paid
Size of connection