11975 SW SUMMER CREST DRIVE 11975 SW SUMMER CREST DPIVE
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PERMIT TO CONNECT
'r,iga.rd Sanitary Distr:id
PERNiI' ' N�► 1 PVDATB
PERMIT IS GIVEN TO
OF
'PO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT —
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THIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMISES UNTIL CON- 6
NECTION IS MADE AND INSPECTION Of CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID ;. .......:.............TIGARA SANITARY DISTRICT
By
,w,,,e,,, .w.wrsrdr. .ar�.Awrv.r�r►r�e
CONNECTION INSPECTED AND APPROVED
Date Superintendent
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Address / q"7j J t,; t�.,,v,,,�,,,� ua/ _ Pern i t No.
Permit charge. Q'
Owner Connection fee
Paid by _,6- ?***"
Type of Building bate connected
Service Rate_ I%spection fee
Contractor_ �,, ,u"�. .r Paid Dat.e /-
Size of connection IL/'' Assessment Paid
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