11180 SW 119TH AVENUE 11180 SW 119TH AVENUE
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT M 968 DATE
PERMIT 19 GIVEN TO .• - ` l/r __—
OF �. _ ► -
TO CONNECT A _ iA' ' —
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED tDN 'rBE DERCRIBEII PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID a .. _............................TIGARD SANITARY DISTRICT
By �
CONNECTION INSPECTED AND APPROVYsD
Superintendent
i
Address �4// // �► Permit No. 7(0_�__ _
Name of Occupant Permit charge.
Connection fee
Paid by -- — -- --
Date connected G ' QQis
Type of BuildingInspection fee
Servir.a Rate Paid by ___ Date _
Contractor Assessment Paid
Size of connection
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