11575 SW BURLCREST DRIVE-1 i
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DRIVE11575 SW BURLCRFST
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Addcesaj/sE7r 4, Yvv4.ccerr Permit No..?7G
Name of Occupant Permit charge
Connection fee Z J o—
Paid by- - -- ---- -- ..
--- _�---- ----- - --- - Date connected G -1 7- �r 7
Type of Building_____ __T_,^_ Inspection fee /0
Service Rate------- Paid by --_Date
Contractor Assessment _ Paid_
Size of connection
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 976 I ATE
PERMIT IS C,IVEN TO —
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TO CONNECT A
TO T11r; SYSTEM OF TIGAR,D SANIT.tRY DISTRICT
AT
TAW PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NEC TION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COW
PLETE.D.
PERMIT FEE PAID $... ...._---............_ 'I WAP') SANITARY DISTRICT
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CONNECTION INSPECTED AND APPROV:FD
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