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Permi t charge_____` 7 `'1r_•'
0wnerY � Connection fee
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Type of building. 5pyy Date connected
Service rate Inspection
Contractor Paid by Date
Size of connection �',;lii _ Ass9ssmer,t Paid�–��
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 1328 i ATE J c.
PUR3111, IS GIVENr
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TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DIS'T'RICT
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THIS PERMIT MUST BE POSTED ON TH$bF.SCRIRED PRFMISFS UNTIL C'ON-
NEC?ION IS 51ADE AND INSPECTION 010/ CONNECTION HAS BEEN COM-
PLETED.
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PERMIT FEF PAIL) ;_,.. ,•,,� TIGARD SANITLRY DISTRICT
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CONNEC7TION INSPECTI'D AND APPROVED
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