8655 SW PINEBROOK STREET 8655 SW PINEBROOK STREET
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Permit charge A �..
)wner________ Connection fee
— Paid by—
'ype of Buildinq Date connecte
service Rate Inspection fee—/-4p. �-
'ontractor �— —� Paid by Date
size of connection ��
Assessment Paid
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 1202 DATE .� s
I'111111'r 1S GIVEN TO _
TO CONNECT A �- —-- -------_�
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED,
PERMIT FEE PAID _..... ��(,�.............TIGARD SANITARY DISTRICT
----- - - - - -----
AM.AAA M
CONNECTION INSPECTED AND APPROVED
Date — ---- —`--- Superintendent --_--__--