13880 SW 115TH AVENUE U U U Woul U U L-1
13880 SW 115TH AVENUE
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PERMIT TO CONNECT
Tigard Sanitary District
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PERMIT N? 1630 DATE LL�'----s-=-
PERMIT IS GIVEN TO -(�t.�4rr �►-�� �"-_
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OF
T%) CONNRCT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCIIIHED PREMISES UNTIL CON.
NECTION IS MADE AND 1,,iSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERWT FEE PAID =- ........c..................TIGARD SANITARY DISTRICT
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CONNECTION INSPECTED AND APPROVED
SupetlntandeIIt --
------------- Date '%
Address 13880 S.W. 115th Ave. Permit No. Xx 1630
Permit cbarge
Owner KKXM Columbia Custom Connection fee 4W
Paid by -same
Type of building Fes. Date connected
Service rate 3-00 per month Inspection fee Z5
Contractor — columLia Custom Paid by Date
Size of connection 4" Assessment Paid