10270 SW BROOKSIDE PLACE-1 i.
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Address /l,?70 k �ce n
/"Permit No._ 7d�
Name of Occupant Permit charge of `
-- Connection fee .2.7) ( i
—-- Paid by J. W i/le c A�
Date connected J".2
Type v. I3i�ildiagh E.S ----
Ir spection fee
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Cc
Sf,rvice Rate � '
Paid by _%7tt 10c K-. Date ter, 63
Contractor
--L ° C -- Assessment Paid
Size of connection
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT V 73 1 DATE �" - 4 IV
PERMIT IS GIVEN TO
OF
TO CONNECT A Z,
TO THE.SYSTEM OF TIQARD SANITART DISTRICT
AT r A
1
THIS PERMIT MUST BE POSTED ON THE DE9CRIBEjPRF,MISF.3 UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONFECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $... '............................TIGARD SANITARY DISTRICT
T�
CONNECTION INSPECTED AND APPROVED
-Date