11610 SW 116TH AVENUE 1-0 Ll l.,J: 1_l �.1 �1 ilrl .U Y QIP -a r .
. • SW 116TH AVENUE
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PERMIT T4 CONNECT
Tigard Sanitary District
PERMIT N . 1228
DATE S- -W (� E
PLS RMI ' 'IS GIVEN TO l�+ai i�:1��J "I
OC
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MIDST RE POSTED ON THE DESCRIBED PREMISES UNTII.CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID ..—-----------
TIGARD SANITARY DIrST�RICT
10
By
CONNECTION INSPECTED AND APPROVED
------- --Date - Superintendent
F
Address____, Permit No.
Permit charge. aZbD
Owner /���� _ Connection fee_
Paid by
Type of building �� ti3o� -� � Date connected
Service rete Inspection fee s10°"'
Contractor 31 Paid byDate �.
"iae of connection Assess ,pnt -Paid______.,_.
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