11585 SW 95TH AVENUE 11585 SW 95TH AVENUE
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PERMIT TO CONNECT
Tigard Sanif:ary Distrid i
PERf'.v[IT N° 629 DATE Ilt
PERMIT IS GIVEN TO
OF
TO CONNECT A_ --.._��_. t_a.L__.e65
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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THIS PERMIT MUST .;E POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $. /.�r ..Q...........TIGARD SANIT.RY DISTRICT
By /
-�� 4ir_
CONNECTION INSPECTED AND APPROVED
Date Sup#i Intcndent
Address _� _ __SW/_ - J _ Permit No._ ,) // a
Name of OccupantcUe;/.g -- &Iar� Permit charge !�Q _Jjj,,.
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!o j � �� 1.11 P���` Paid by -e
Date connected ,0LI 4 c
Type of Building__VA414Intttpection fee_./(�Q�
Service Ifate___j. (Q O Paid by 6 _/�—Date ""v
Contractor— f. _ Assessment C. 141APaid_
f Size of connection