11205 SW 119TH AVENUE *� ,MIT 1 111111111
11205 SW 119TH AVENUE
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PERMIT TO CONNECT
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PERMIT No 949 DATE
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TO CONNECT A , K
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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THIS PERMIT MUST BE POSTED ON THE DE.9CRIBE!2 PREMISES UNTIL.CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS DEEN COM-
PLETED.
PERMIT FIFE PAID ;._. ..........................rIUARD SANITARY DISTRICT
By
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CONNECTION INSPECTED AND APPROVEll
Late i Supedntendent—
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Addrese�� '. ��I Permit
Name of Occupant Permit charge
Connection fee
------- — - -- Paid by
Date connected J� G 7
Type of Building -_ -_ Inspection fee
Service Rate. _ ----— - --- --- -- Piid by ---
Contractor., Assessment Paid
Size of connection