11490 SW 121ST AVENUE 9I/ M M w t
11490 SW 121ST AVENUE _
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PERMIT TO CONNECT
'Tigard. Sanitary District
PERMIT N9 141.6 DATE
PERMIT IS GIVEN TO
OF
TO CONNECT lkTO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT Faso PAID ;..........�.7 ..TIGARD SANITARY DISTRICT
�2 S moi%
CONNECTION INhP ('TFD AND AP13ROVFD
Dute Superintendent
Adaresc 11490 S.W. 121st Ave. Permit No.,--_.lA_16___
Permit charge_._________
Owner Dale Cnnstruction (Contractor) Connection fee 375.00
Paid by
Type of building Res.--- Date connected—Not_SurC
SE!rvice rate Inspection fee
Contractor Dale Construction Paid by
Size of connection— 4 Assessment Pald-----.
Start billing 1.9t of August
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