13410 SW ASH AVENUE T
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1341.0 SW ASH AVEN.IE
Address 1, .eA l o_ v a4--,1, Permit No.
Name of Occupant _ — Permit
Connection fee
Pai i ;:,v_
------. -- _ __ Date co•.inected - -- __--
Type of Building-- --_ ---- I•aspec,ion fee-- -- _-
Service RatePari by
Contractor Assessment Paid
Size of connection
PERMIT TO CONNECT
Col Tigard Sanitary District 0 'C
PERMIT V) 955 DATE 10
PERMIT IS GIVEN TO
OFTO CONNECT A - —Y_
TO THE SYSTEM OF TIGARD SANITART DISTRICT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTII,CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $.... _.:...........................TIGARD SANITARY DISTRICT
By
44 r_L
CONNECTION INSPECTED AND APPROVED
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Date _ — Superintendent
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