11935 SW SUMMER CREST DRIVE x
11935 SW SUMMER CREST DRIVE
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Address;,,i� r�h�- -a-�t _ _ Permit No.���s
Name of Occupant Permit charge
Connection fee
--r - - - --- - — -- -- Paid by .-----
Date connected
Type of Building Inspection fee
Ser•,ice Rate Paid by Date_��
Contractor_ - --- - --- ---- -- - Assessment--- - '"aid
Size of conneJion
PERMIT TO CONNECT
Tigard Sanitary District
]PERMIT IN 065
PERMIT IS GIVEN
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISE-;UNTIL^,ON-
NFCTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $.... .............................TIGHT.D SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED