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`11840 SW BURLCREST DRIVE 1�
Address
/t4V Permit No.
Name of Occupant__ Permit charge 2-
Cnnnection fee
Paid by
L'ate connected
Type of Building— Inspection fee?
Service Rate Paid by Date
Contractor Assessment-. Paid
Size of connection
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PERMIT TO CONNED f
City of Tigard
Permit N? 855 DATE
P/KNIT If GIVtN
TO col.1:1ECT
TO THE SYSTEM OF CITY OF TIGARD
T141S PERMi i MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON.
NECTION IS MADE ANEW INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FFE PAID $ "L -_--..CIT'Y OF TIGARD
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CONNECTION INSPECTED AND APPROVED
Date