12000 SW SUMMER CREST DRIVE 12000 SW SUMMER CREST DRIVE
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PERMIT TO CONNECT
City of Tigard
Permit N° S t 0 DATE
PERMIT IS GIVEN TO _ A ,��-�._ +'_l_+_-�� ._.,8��.�•
TO CONNECT s ----
TO THE SYSTFi.! OF CITY OF TIOARD 1 j
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL COW
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID $ -I_.-�.__—..-. CITY OF TIGARD
LIJ
>) 50
BY
CONNECTION INSPECTED AND APPROVED
oar,+ SuperinNndOnt n —
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Address le?00 D �J�-®��..: _ Permit No.
Name of Occupant__ _� Permit charge -----_---- -__-- - - -`- -
Connection fee
---- --- — ---- — Paid by------ -- -
- -- __._----- __--- Date connected C�
Type of Building-_.__- Inspection fee;
Service Rate Paid ;-y Date
Contractor Assessment Paid
Size of connection
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