11410 SW 90TH AVENUE 11410 SW 90TH AVENUE
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT iv° 781 DATI
PERMIT IS GIVEN TO
OF
TU CONNECT ATO THE SYSTEM OF TN3ARD SANITARY DISTRICT
AT
DjSCRIBE
NTIL CON-
NEIS
THISPERMIT
MADE AND) NSPECT ON OT CONNECTION PREMISES
BEEN COM-
PLETED. ,
PERMIT FEE PAID .............................TIGARD SANITARY llTw i'RICT
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CONNECTION INSPECTED AND APPROVED
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Permit No.
Name of Occupant �.9k'� (ha!CNl Permit charge ��
Connection fee
---- --- ---__---. _ Paid by-- I AC6 19etlyS
---- —__-- Date connected3���
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Type of Building es.aEA r Vel fee__ el
Ser;�.ie Rate_ ) Paid by e�)W -.vr _Date 431-j'
Con tractor_ .CA� i Assessment Paid
Size of connection— .-
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