11640 SW 116TH AVENUE 11640 SW 116TH AVENUE
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PERMIT T6 CONNECT
Tigard Sanitary Dic-trict
PERMIT N9 13`' 9 DATE
Q
PERMIT IS GIVEN TO _
OF
TO CONNECT A
TO THE SYSTEM OF TNiiARI1 SANITARY DISTRICT
AT
THIS PERMIT MUST BF. POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETEP.
PERMIT FEE PAID $.. ........................TIGARD SANITARY DISTRICT
BY
CONNF.G"f10N INSPECTED AND APPROVED
-Sulierintendent
Address c �/� �� Permit No. 1 -315-
Permit charge,
�A ( ;e,-.�,'f�,i.S_,►
Connection fee .575c90
Owner
Paid by -
Type of buildinDate connected
Service rate.
Inspection fee„ ,J��
Contractor _ Paid by Date
Size of connection Assessment -Pa:id _--
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