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Address 7O U A&-l JDE-- Permit No. 5?S�
Name of Occupant Permit charge 2 =_
--___ Connection fee—Z y
Paid by __ ---- -- --
__ _ ------_-- -- `--__-- Date connected
Type ca' Building IQe Inspection fee__ /0
Service Rate Paid by _---_-- -_- - gate-_____--
uontrac+.or __-_ Assc sstnent Paid
Size of ccnnecfion
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PERMIT TO CONNECT
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igard oan a tart' District
PERMIT N? 980 DATE 1'.
PFRMPT IS GIVEN TO
OF —•_ —� _ _ _ ,_ _ —_
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY WSTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL f ON.
NECTION IS MADE IND INSPECTION OF CONNECTION HAS BEEN ::OM-
PLETED.
PFRMIT I-)-,E PAID ;.... :..........................TIGARD SANITARY DISTRICT
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CONNECTION INSPECTED AND APPROVED
---------Dae -- — Superintendent