11975 SW BURLCREST DRIVE LJl-
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11975DRIVE
AddT•ess /0�17,�' � � Permit NooA/d-y �.
Permit charge_
owner ����'U d/�, ��'�,;�.___ Connection fee .3-2
Paid by �..�._�...�
Type of building , -_ Date connected__ _,[-7� 1/
Service rate - Inspection fee___;)5`"
Contractor Paid byDate__
Size of connection `�' Assessment__,.____..._._--_ 1. a ' 'J-----
PERMIT TO CONNECT
Tigard Sanitary District
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PERMIT N° 14 P3 DATA _
PFR3117 IS GIVEN TO --- - -_ A� -_---—
OF
TO CONNECT A
TO THE QYSTEM OF TIGARD SANITARY DISTRICT
AT �4
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
P/'RMIT FEE PAID $...._............................TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
Date Superintendent
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