11995 SW MANZANITA COURT ..1995 SW KX4ZANITA G`G"T
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Addressr c�_5 J � ,, � Permit No.�(
Permit chargee
Owner Connection fee—
Paid
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Paid b y
Type of Building Date connected
Service Rate y Inspection fee asp _
Contractor--� 2��'d c� Paid byZrirw Date
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Size of connection Assessment aid
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT M 1120 DATE
PERMIT IS GIVEN TO
OF
TO CONNECT A TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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 . [STRICT
By
CONNECTION INSPECTED AND APPROVED
Date Superintendent
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