11155 SW 119TH AVENUE 11155 SW 119TH AVENUE
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PERMIT TO CONNECT
Tigard. Sanitary District a�
PERMIT N9 953 DA'L'E
PERMIT IS GIVEN TO
OFTO CONNECT A -
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE. AND INSPECTION OF CONNECTION HAS t1FEN COM-
PLETED.
PERMIT FEE PAID $.......Wf ...11 .............TIGARD SANITARY DISTRICT
A SU 'tu-
CONNECTION INSPECTED AND APPROVED
-- Date Superintendent
V /
Address w Permit No.
Name of Occupant_ _ Permit charge
Connection fee
Paid by_
Date connected &V
Type of Building_ Inspeotion fee
Service Rate Paid by Date
Contractor _ Assessment —Paid------
Sip-
aid_ ___—
Size of counechun