12050 SW 121ST AVENUE lWrw'Y
l.�l)50 Sid 111:7' AVENUE; --
L
y
N
N
a
LM
0
i
I
PERMIT TO CONNE;;T
Tigard Sanitary District
PERMIT N9 1069 DATE
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OP TIGARD SANITARY DISTRICT
AT
THIS PERMIT MINT BE POSTED ON THE DESCRIBED PREMISRS UNTIL CON-
NE(.1rION IS MADE AND INSPECTION OF CONNECTION HAS BETON COM-
PLETED.
PERMIT FEE PAID $. . ....TIGARD SA%ITARY DISTRICT
By
✓.nn.ti.ti�wn.an'r`� w�ww.w.�.Meen.�nr�rw
CONNE(,'TION INSPECTED AND APPROVED
i
i
f
ly
Address/-�OJ()-& 1.21y-1 . - Permit No.� 9
Name of Occupant Permit charge
Connection fee
E '
--------- - --_ .__------- Paid by C
--_ _ Date connected
Type of Building _ _ Inspection fee
Service Rate Paid by _ - Date��
Contractor------_____ Asseabment_
-- _Paid-----
Size of connection
I
1
I
I