12195 SW 116TH AVENUE-1 1
12195 SW 116TH AVENUE _
u
�D
3
,n
y�
N
i
I
PERMIT TO CONNECT �`�
Tigard Sanitary District
PERMIT N° 1314 DATE -- ,- - Y- •--
PERMIT IS Gil EN TO --
i
OF
TO CONNECT ATO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT ML)9T P.F. POSTED ON THE DEQCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND IN,'PECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID ...... ............................TIGARD SANITARY. DISTRICT
Br
CONNECTION INSPECT ED AND APPROVED
--.---___-__— Date —� ��� �BuPerintrndeat
i
�QV
Address_,i, /y . ,,_ _ y, Permit No
Permit charge <_
Owner Connection fee
--t7 ' `/n Paid by —
Type of Building 1��' Date connected
Service Rate Inspection fee
Contractor Paid by _^ Date,` = .a
Size of connection �� Assessment Pais?