12025 SW MANZANITA COURT �w at � w s� an sa iw
120,25 SW MANZANI A COURT
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AdcL-:- Permit No. Q--
Name of Occupant_ Permit charge
Connection fee
------- - --- _ --_ Paid by ---------
—_-- Date connected
Type of Building _ Inspection fee
Service RatF . Paid by Date-2 7-Z 7
Contractor __--------- ------- ---- Assessment- Paid--___��_�_
Silo of connection
PERMIT TO CONNECT
Tigard Sanitary District
PERMU N° 1055 DATE �;� - - '7
PTRMIT 1S GIVLN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY D15.WCT
AT
THIS PERMIT MUST BE POSITED ON THE DESCRIBER PREMISES UNTIL CON-
NECTION IS MA))L AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED,
PERMIT FEE PAID $.... ...........................TIGARD SANITARY DIb_ 4ICT
9 4 i3 By
CONNECTION INSPECTED AND APPROVED
mate Superintenarci�