11085 SW 119TH AVENUE-1 11085 SW 119TH AVENUE
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT NU 1034 DATE
PERMIT IS GIVEN TO --
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OF ,--TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY D14TRICT
AT
THIS PERMIT MUST BE P03TED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $.. . ............................TIGARD SANITARY DISTRICT
(3 a fly
CONNECTION INSPECTED AND APPROVED
Dete —_- --- — Buperintendent
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Address��� �`s._����_ '�`5--- Permit No.
Name of Occvr•nnt .- Permit charge
Conne -1,on fee 24%) —
Paid by__._
Date connected—'_0
Type of Building 7 Inspection fee_ -
Service Rate—_ __ Data
_
Contractor —.. -- Assessment_ --
Size of connection