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11950 SW 119TH AVENUE-1 t , AddressPerrriit No ra,�Gt . Name of Occupant_ Permit charge . c Connection teems O C' r" ---- Paid by --- _- __ Date connected //�,�.3 16Y Type of Building-� z- E Inspection fee_ Service Rate_ 4 O _ Paid by {��[ �tt¢-� Date /f A3Z -� Contractoz !C l irt,E`'% i�/• ����6'l! APaid - ssessmc at Size of connection All PERMIT TO CONNECT City of Tigard Permit N° 610 DATE—__-__' a' PERMIT IS GIVEN TO `. .. TO CONNECT A—___- ` __.. TO THE SYSTEM OR CITY OF TIOARD r THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON- NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED. PERMIT FEE PAID ; ���___ CITY OF 'IGARD By CONNECTION INSPECTED AND APPROVED Dnte Superinlendent