14405 SW 92ND AVENUE 14405 SW 92ND AVENUE
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Add ress,[ { af _ Permit No.
Permit charge 4 Y_
Owner Connection fee
Paid by -(J
Type of Buil6ing` _ Date connected f (�
Service state _ _ Inspection feel
Contractor C . �..�_�� Paid by`_ ��Date
Size of connection Assessment Paid
PERMIT O CONNECT
Tigard Sanitary- District
PERMIT NI) I I h 3 1 ^11,
PERMIT IS GIVEN TO _OF
TO CONNECT A .'
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DEWRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID li ................I..........rIGARD SANITARY DISTRICT
By
Ll-
5 S-
CONNECTION INSPECTED AND APPROVED
Date Supeiin' -n dent