11680 SW 121ST AVENUE-1 11680 SSV 121S'.- AVENUE
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PERMIT TO CONNECT
Tigard Sanitaiy District
PERMIT V, 9 7'7 DATE 2
PI?RMIT IS GIVEN TO
OF
TO CONNECT A —
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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THIS PERMIT MUST RE POSTED ON THE DERE RIRED PrF.MISF9 UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION IIAS BEEN COM-
PLETED.
I'FRMIT FEE PAID ..... ........... ...............TIGARD RANI'FARY DISTRICT
J Tri BY -- l ---- --
CONNECTION INSPECTED AND APPROVED
A)
_. ._.---.Date ,--
MW ff I/
1
Addressl�li�aswh2L,1�• Permit No. 977
Name of OccupantPermit charge ._!
Connection fee -2%00 ! —
Pd:.; by ---- -
Date connected
Type of Building_ _ Inspection feed_
Service Rate __ Paid by Date--
Contractor
ateContractor._ Assessment.__--- ____-Paid
Size of connection