11710 SW 121ST AVENUE-1 w
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PEYMT TO CONNECT
Tigard Sanitary, District
PERAIT N98 4 DATE•
pEW1IT IS GIVEN TO I1_yL L OF
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Tn CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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Al
THIS PERMIT MUST R- t'OSTED ON THE DESCRIBED PREMISES UNTIL CON-
NEk'"fION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLFTED.
PERMIT FEE PAID $ .. . ... ..................'CIG ARD SANITARY DISTRICT
CONNECTION INSPECTED AND APPROVEII
-- Pate
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Address/17 J w /1/I T Permit No.
Name of Occupant_ Permit charge ,-.2 2J --
O
Connection fee _
Paid by _
— _ Date connss.Iad _7
Type of Building_._��'�
Inspection fee_ 16
Service Hate., Paid by Date
Contractor _ Assessment Paid _
Size of connection
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