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Address Permit No.
Permit charge
Owner ` Connection fee 0
Paid by_
Type of building Date connected
Service rate Y-(19 Inspection fee__—Zc, ll0
Contractor Paid by Date
Size of connectional Assessment Paid
PEWIT TO CONNECT
Tigard Sanitary District
PERNAIT 9 1474 DATE
PERMIT IS GIVEN T13
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
THIS PERMIT MUST HE POSTED ON TJIE DF9CRIHED PREMISES UNTIL CON-
NECTION 18 MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED,
PERK'.A FEE PAID S ...TIGARD SANITARY DISTRICT
By
(ONNECTION INSPECTED AND APPROVED
Date sup,