11900 SW 116TH AVENUE 00 SW 116TH AVENUE
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PERMIT T4 rONNECT
Tigard Sanitary District
PERMIT N° 1191 DATE ___
PERMIT IS GIVEN TO ,— �---_-,-_ -- —
Or --------- ---_—_ _— —
TO CONNECT A --------..--
TO TLE SYSTEM OF TIG.ARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DE7CRIBED PREMISES UNTIL CON-
NEC.`T10N IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETIED.
PERMIT FEE PAID S. . ._....................TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
Date
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Address Permit No. ;,/5-,/
Permit charge
7 — �.
Owner -��- Connection fee �.:1,nr 0
Paid by
Type of Building Date connected_
Service Rate Inspection fee
Contractor Paid by` —Date—
Size (:,A' connection Assessment_ Paid_
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