13665 SW 110TH AVENUE-1 13665 SW 110TH AVENUE ._
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Address 13665 S.W. 110th Permit No. 15,4n
Permit charge
Owner Ray Anderson, Jr. Connection fee 300.00
Paid by_ _._.._.�__._�..._._..—_.
Type of building Res. Date connected____j4a44
Service rate Inspec-�ion
Contractor Paid by , ,)at
Size of connection 401 Assessmey.t i<a ! J
PERMIT TO CONNECT
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�� �;z. Tigard Sanitary District*
PERMIT V 1540 DATE
r1l(1I1l• 15 u1vrN ToOF
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TO CONNECT A t —
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMI!IES 11NT1►,CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
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PERMIT FEE PAIDT161It1) SANITARY 1►1lit l.'P
By
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CONNECTION INSPECTED AND AP}ROVED
Bate --