11700 SW 116TH AVENUE Ll Li 0-1 1,,..1 111_.1 l,.l 10 lel I
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11700 SW 116TH AVENUE
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 117 7 DATE/
PFRAIT _ � -
IS GIVEN TO �e�r'"�'-►+irk
OF _ -------- ------�.__�. ----- _
TO CONNI3CT A ---- ......
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT_/L2,oj
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PRtm.,SES UNTIL CON-
NECTION IS MADE. AND INSPECTION OF CONNECTION AAS BEEN COM-
PLETED.
.+�
PIIRMIT FE8 PAID 1• ....4,...)............. SANITARY DISTRICT
('ONNE("1CION INSPECTED AND APPROVED
--•- Date —�.—'__._ _ 8uperintrndent—
Address /70v .(u J l (nrt - Permit No, /177
Permit charge
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Owner �i� n;,; c �� [�i, r_,r11 ,t Connection fee
Paid by
Type. of Building U, �, S9 ` Date connected_^_Y
Service Rate Inspection fee
Contractor_ Paid by_ _Date_
Size of connection j Assessment Paid
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