11990 SW 121ST AVENUE -LI u u SLI a Q u ALJ
•• SW 121ST AVEbUE
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PERMIT TO CONNECT
Tigar:.x Sanitary District
PERMIT N° 1111 DATE
PERMIT iS GIVEN TO
OF —
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON 'I'llE DESCRlnF.D PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERIliiT FEE PAID $._.. .............................0(:ARD SA"ITARY DISTRICT
Rv
CONNECTION INSVECTErI ANI' APPROVED
]Date Superintendent
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Addre_s ��C' G°� / Permit No. 11/�
Permit charge .2o-„
Owner _ Connections fee,) �-) �
-- --._------ Paid by I
Type of Building Date connected
Service Kate Inspection fee /
Contractor j _ Paid Date...' -/_3 tj
Size of connection` " _ Assessment Paid`
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