14137-14139 SW 103RD AVENUE 1
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14137-39 SW 103RD AVENUE
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 1204 DATA
PERMIT IS -Lsl:'aN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIrxARD SANITARY DISTRIC
pus PERMIT MUST BF 1,00—ED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IE MADE Al, INSPECTIO"I OF CONNECTION HAS PREM COM-
PLETFD.
PERMIT FEE PAID5l............TIGARD SANITARY DISTRICT'
By
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CONNECTION; INSPECTED AND APPROVED
Dai.e Bvperinten�ent
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Address�� , '� ��/ ic; c Permit- No.
Permit charge
Owner . : : Connection f,ae
Paid by _
Type of Building_ L1 _sGDate connected _
Service Rate Inspection fee `
Contractor Paid by_`_-._y _ __ ____,Date.
Size of connection_ Assessment Paid