13490 SW 115TH AVENUE 13490 SW 11 5TH AVENUE
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Address S:af i�•5*'�'lr.u� Permit No.
Permit charge
Owner ,. du- ��.,.<< _- Connection fee
Paid by
Type of building �'�.� Date connected
Service .rate .__ Inspection fee ,
Contractor Paid by_ Date_
Size of connection_ '�� Assessment Paid�
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PEPIAIT TO CONNECT
Tigard Sanitary District
PERMIT N9 1356 DATE //-
PERMIT IS GIVEN TO ., �r ^ ---
TO CONNECT A _�
TO THE SYSTEM OF TIGARD SANITARY PiSTRICT
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AT Th 1341.;
THIS PERMIT MUST BE POSTED ON 1HE DESCRIDED PiREMISRS UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM- �
PLETED.
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PERMIT FEE PAID �i. .3..�... .........TIGARD SANITARY D.ISTXICT f
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p 4„t.�„ ,�,4 till i
CONNEIC ION INSPECTI'D AND API'1(0114)
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Date Superintendent �