11695 SW 79TH AVENUE-1 11695 SW 79TH AVENUE
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PERMIT TO CONNECT
T.gard Sanitary District
PERMIT 1�1c1 1035 DATE _ ----- —
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PERMIT IS GIVEN TO
TO CONNECT A
TO THE SYSTEM OF TIGARD SeLNITARY DISTtICT
AT
THIS PERMIT MI1FT BE POS"Uh ON THE DESCRIBED PREM/SFS UNTIL.CON-
NECTION IS MADE; AND INS 6 XTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $. .. . ................/..TIGARD SANITARY DISTRICT
.l q U By
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CONNEf-TION INSPECTED AND APPROVED
Date %wrintender,,
Address 116 VS_4W 7CZA,_t Permit No.
Name of Occupant Permit cbarge
Connection fee
Paid by
Date connected 7
Type of Bufldin(, 1'e&
Inspection fee
Service Rate---------- Paid by Date_
Contractor Assessment-----—.-----Paid
Size of connection