11760 SW SUMMER CREST DRIVE 11760 sw :'HmmF R
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PERMIT TO CONNECT �
5'
Tigard Sdnitary District
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PERMIT () 1 S(�r1 DATE > .----
PERMIT IS GIVEN TO .
OF
TO CONNECT ATO THE SYSTEM OF TICARD SANITART X[STRICT
ATTHIS PERMIT MUST BE POSTED ON TdE DESCT.IBED PREMI874S UNTIL CON-
NECTION IS MATE AND INSPECTION OF CONNECTION IIA,3 BEEN COM-
PLETED.
PERMIT FEE PAID $.... .......:....................TIGARD SANITARY DISWRICT
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CONNECTION tNSPECTEII AND APFROVFD
Date -_--- — - Superintendent
Address //7G1� ���- � � C�� �7Permit Nr,,.—
Permitohar;;e�
Owner ( .���� (,; � t >; Connection fee---- � /5lie
Paid
Type of building Date connected
Service rate Inspec cion fee ---
Contractor
ee _Contractor Paid h
y,_„_� Date
Size of connection Assessment Paid
a t ci, ►I I-,,� 7