11935 SW BURLHEIGHTS STREET i�
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Address% J,5- r4//.Udw.a e oyPermit No. 9
Name of Occupant Permit charge
Ccnnection fee
_ Paid by_ _ --
___ Date connected
Type of Building—. _ Inspection fee
Service Rate,— — -�_-- Paid by _- --Date— —
Contractor �.._____ Assessment Paid
Size of connection
W
PERMfT TO C ECT
Tigard San.i+ary istrict
PERMIT N? 9 fel DATE
PERMIT IS GIVEN TO _
OF
TO CONNECT A
TO THE SYSTEM OF TIGARII SANITARY DISTRICT
AT
_...-- ----------_.____ -----------_.---------_--
THIS PERMIT MUST RE POSTED ON THE DE>.;r)tll'ED PREMISE'S UNTIL CON,
NEC"TION [S MADE AND INSPECTION OF CONNF(,"TION HAS BEEN GJM-
PI,ETED.
PERMIT FEF PAID 3... .......`.."'.............TIGARD SANITARY DISTRICT
Ry �
CONNECTION INSPECTED AND APPROVE.[)
_�__Supertnten ent___—