12020 SW BURLHEIGHTS STREET-1 .p• , 4r1; L ,V la 1160
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1-2020 SW BURLHEIGHTS, STREET
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Address/ 0 a 0 ,1 #V � 4A.N--A 0&IV?1 Permit
Natne of Occ,.pant_--- ---- _ Permit charge '---- ----_---- -_-------
---- — ---- ----- Connection fee_
-- -- ---_ - - Paid by
Date connected.
Type of of Building I C..a� Inspection fee 1 Q "
Service Rate.- -_ P,aid b Date-
- --
Contractor,_ _ _ A,;aesswant Paid
Size of cor.nection _.
PERMIT TO CONNECT
Tigard. Sans i-ary District
PERMIT N9 1016 DATIw
PERM➢T IS GIVEN TO
or
TO CONNECT A
TO TINE SYSTEM OF TIGARD SANITARY DISTRICT
AT / Y
THIS PFotMIT MUST BE POSTED ON TOE Di:gCR!HED PREMISES UNTII,CON-
NECTION IS MADE AND INSPECTION OF CONNECTIOF HAS BEEN CO1V1-
PLRTED.
PERMIT FEE PAID .........................TIGARD SANITARY DISTRICT
By
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( ONNI-ITION INSPECTED AND APPROVED
-- Date---- ----- Superintendent