12055 SW 118TH AVENUE r r I r 1 Iu r 1 ;
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12055 SW 118TH AVENUE
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PERMIT TO CONNECT
Tigard. Sanitary District
PERMIT N9 1084 DATE ----- ..
I'I?ItMIT IS GIVEN TO
OF
TO CONNECT A -- -- --_—� ------__-__.------�-
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT �-
THIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMBES UNT17.CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN "OM-
PLETED.
PERMIT FEE PAID $.. . ... .....................'TIGARD SANITARY DISTRICT
S 3 9� By
CONNECTION INSPECTED AND APPROVIA)
Date B*,Iperintendent
Address /�� L'J.S sGl ��4 Permit No, l��T
Permit charge
Owner Connection feet'_
Paid b y_S& t ruct a s wr C e
Type of Building Date connected
Service Rate_ Inspection feeJ( `
Contractor. Paid byj t1, ,(A Date_
Size of connection-- _ Assessment Paid
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