11965 SW BURLHEIGHTS STREET J4
^a
i
a�d
Address f/�G J .�/ Permit No.--��-t-f �s—
Name of Uccupant ____._ Permit charge
Connection
Paid by-- -- -- ---------------- ..-
--- --- ---- ---- -- Date connected
Type of BuiHing Inspection fee_/-IP_ -
Service RatePaid by - _- Da;r? — -- ----
Contractor Assessment Paid
Size of connectiDn
PERMIT 'TO CONNEC-i
City of Tigard
Permit N° A, 4 D,,TE .7 -14___Ss
PERMIT IS GIVEN TO
IN
TO CONNECT A -.=••�--
TO THE SYSTEM OF CITY OF TIGARD
AT
1415 PERMIT MUSY BE POSTED ON THE DESCRIDZI1 !'REMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT F•cE PAID $ ---'^ w CITY OF TIGARD
77
1�,�►,�.•r„�rrn1�,�r7fLiZ,�ih�•.�ra.rn�.".rrornrri�or,rwr"��.re
CONNECTION INSPECTED AND APPROVED
0 `t)
Date - Superintendent
'xlf:'ik,":�...;.- :k1l7Rlf '. '. a id�SIY��N 69k, '�9�td`1 .;(': `e'-:. .. .,y,� ... ,.""r,•�,.1;„y�,p..
l
F