14135 SW 103RD AVENUE-1 lAw
14135 SW 103RD AVENUE
1
I�y •�
r
Addressp '�/.3�.7`� �Q- .Qom__._. Permit
Name of Occupant -- Parmit charg ---
Cnnnec+ion ,,ee
T'aid by _.
Date conn�xied.
Type of Building___-..___._ Ina^•e!ctior, - -- _-
Service Rate---------- --- -—_ _ _--- Pe id b:rr -Date�_a
Contractor _Paid
Size of connection
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 936 DATE _
PERMIT IS GIVEN TO lam• =OF
TO
TO CONNECT A -_-_—_-
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE.DESCRIBED PREMISES UNTIL CON-
NECTICN ji-m "NPLDE AND INSPECTION OF CGNNF'rTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID 3... r..........�...............TIGARD SANITARY DISTRICT
By
�f
p�
CONNECTION INSPECTI?D AND APPROVED
o:)
_-_� --- Date --�~� Superintendent -