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PERMIT TO CONNECT
Tigard. Sanitary Di .1trict
PERMIT 119 1061 DATE
PERMIT IS GIVEN TO - — -�r_. _----- 7 e+w. Y � c..< r'" .r�°�•
OFTO CONNECT A ---
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON TN.E DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAE BEEN COM-
PLETED.
PERMIT FEE PAID $..... ...........................,TIGARD SANITART DISTRICT
BY
CONNECTION IN`WCTED AND APPROVED
Date _.____�� -----• —Superintendcn*__�
Address/%V%S% _- - PervAt No. 14264
Name of Occupant_ _ ___ Permit charge
Connection
Paid by —
Date connected _
Type of Building__— Inspection fee _- ---
Service hate 'aid by _ 6 �7
Dats1�
Contractor Assessment_.---_—Paid
Size of connection .
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Address a`S�el�"�''---7E - Permit No.1��
Name of Occupant _ Permit charge
Connection fee
Paid by—_ —
Date connected
Type of Building / , Q_..___ Inspection fee --
Service Ante._.._-_------_._-__ __ __p_-- Paid by -_-_-- Date_ _
Contractor-- .--_. _______ Assessment--- Paid _
Size of connection --
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