11740 SW 121ST AVENUE 0'
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PERMIT TO CONNECT
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City of Tigard --
Permit <> u 8 DATE a
PERMIT IS GIVEN TO
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TO CWINECT A ---
TO THE SYSTEM OF CITY OF TIGARD
THIS PERMIT MUST BE POSTED ON THE D%-SCRISED PREM";ES UNTIL CON•
NiCTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLECED.
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PIRMIT PB/ PAID I<___:L__. _. CITY OF TIGARD
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CONNECTION INSPECTED AND APPROVED
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Superintendent
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"WA�WWMR 111
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Address11,74CJdaz 11/44 , Permit No.
Name of Occvpant� Permit charge
Connection fee
- -—- --- —__ Paid by--- ---- — _— ---
__.—_.._. Date connected - '5
Type of Building Inspection fee
Service Rate`----------------__-_-- Paid by Date W_ —
Contractor_.-----_- -_--_---__ -_ -----_ _-_ Assessment_ - - Paid - ----__--_—
Size of a.,nnection _ ___-