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PERMIT TO CONNECT
Tirrard Sanitary District
PERMIT N° l 1015 DATE •�/!`
'. YER1111T IS GIVEN TO
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OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SAKI VARY DISTRICT -
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED,
PERMIT FEE PAID ...................TIGARD SANITARY DISTRICT
By
MAMAMMMA
('ONNFCI'ION INSPECTek) AN5) APPROVE))
Date _ -- Superinten�ent
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Address.&,QJ%5: �Ll-!F7H _ Permit No.LQl J�
Name of Occupant _ Permit cb nrge
-- --- Connectior `-,o. I -
Paid by____......
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�._---�— — ___--_-- Date connected.__
Type of Building _— Inspection fee—/P —
Service Irate _ __. _ Paid by Date,
Contractor __ Assessment Paid _
Sire of connection