11580 SW BURLCREST DRIVE-1 o .
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Address/IW or"l���- Permit No.
Name of Oc,,upant____- _ _ Permit charge
Conrection fee
Paid by _
Date connected
Type of Building Inspection fee
Service RatP _ _ Paid by _Date__.____
Contractor
_----.�_--�_—-- Assessment-—--Paid
Sipe of connection
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PERMIT TO CONNECT
Tigard Saniti.ry District "3
PERMIT N�) 960 riATZ '.:71 "1
PER311T IS GIVEN TO
OF
TO CONNECT A 1. S
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST RE POSTED ON THE DE-SCRIBED PI-.F.MISES UNT1I.,CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAIL) . . ............q IGARD SANIT..nr DISTRICT
By
CONNECTION INSPECTED AND APPROVED
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Date — ------
-- 8uperintendent _ ___--