12095 SW 118TH AVENUE -- 12095 SW 118TH AVENUE
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PERMIT TO CONNkcr
Tigard Sanitary District
PERMIT N° 10(,2 DATE <�• ��,'" - ' 'r
PERMIT IS GIVEN TO. i��� !�-,.�7 t�,.�,.o+ r-4"•� �t�
OF
TO CONNECT A,�— "__.. ..�-
TO THE SYSTEAI OF TIGARD SANITARY DISTRICT
AT Lam,' 'I J_ R!��•) // l 7 --THIS PERMIT MUST BE POSTED ON THE DEWF.IRF.D PREMISES UNTIL CON-
NECTION 19 MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLF;TED.
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PE;R311T FEE PAID =.2...........
..._...........TIGARD SANITARY DISTRICT
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By
CONNECTION INSPE(,'TFD AND APPROi'F.D
Superintendent
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Address_ge .9,� Permit No. I U G Z
Name of Occupant_ _ _._ Permit charge
----- ------- -------------- ------ Connection fee 20 "
----- --- -- ---- -- — ---- Paid by-L7., .7 1-�V-(.1AA-LV C —-
Date connected F ..2S- 4a
Type of Building__R5_.S_____------__-- __-- Inspection fere-/_- _
Service i latePaid by -- -_ --
------_- -- --_---Date------------
- _ - -
Contractor----. _—_._ _.__ —_ Assessment-________---Paid
Size of connection