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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 656
PERMIT IS GIVEN TO
TO CONNECT A_ ►� _��
TO THE SYSTEM O: TiGARD SANITARY DISTRICT
AT
THIS PERMIT MUST HE POB'r.FD ON THE DE9C9 .—D PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID ..... .........................TIGAkD SANITARY DISTRICT
By ark t 'llh
"rtiArM.�MrA/.r
CONNECTION INSPECTED AND APPROVED 1
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� Date_..._.... :- —-- -- --- -- ---gyp --to ent ..
Address U "I Permit No.
Name of Occupant ' , 'FP rAv'c1 aicj
111—IIJ
Connection fee /a 0 0,U U
Paid by.�' hin CE 4
----- -- - - .-. ------- Date connected � - -—
Type of Building ����T_— `. Inspection fee.%c �r� - .-_-_R'w
Service Rate 'i J _ __- Paid by, -Date-/
7
^ontractor !% Assessment_
Size of connection �23 __— c a!14'V V