12010 SW SUMMER CREST DRIVE 12010 SW SUM:', CREST DRIVE
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PERMIT TO C$NNEC f
City of Tigard
Permit N(a 54 DATE
PERMIT 15 GIVEN TO ��_ i- ! u� Ll�t���"S _–•--.
OF Jy7 7CJ �: .._ '� '�(r�! ` �rlrIL/[YaA./1—_�__� _.
TO CONNECT P
TO THE SYSTEM OF CITY OF TIGARD /
AT_—!__i 11.�
THIS PERMIT MUST Of POSTED ON THE DESCRIPWO PREMISES UNTIL COW
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLITMD.
PERMIT FEE PAID :_ 'x' _____ ______CITY OF rIGARD
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CONNECTION INSPECTED AND APPROVED
Date Superinfendent
AddressO/C� _ �� -+- Permit No. 1?115 ----
Name of Occupant — Permit charge_-2
Connection fee ?
---- �_- -- - — -
Paid
Date
------ b --. --
Date connected
Type of Building Inspection fee_._
Service Rate - - --- - Paid by --Date__... - - -
Contractor___.__ Assesament
Size of connection