11600 SW BURLCREST DRIVE-1 1
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Address// Oa.X.j4QPRt,,c,*c r ba Permit No. 910
Name of Occupa-A Permit charge_
Connantion fee
Paid by
Date connected :z
Type of Building._ Inspection fee
Service Rate Paid by Date__._
Contractor Assessment Paid _
Size of c:•nnectiou
PERMIT TO CONN ,C;T
Tigard Sanitary District
PERMIT N9 910 TATE : - i /
PERMIT IS GIVEN TO --___ A
OF
TO 7ONNECI` A
TO THE SYSTEM OF TIGARD SANITART DIS kICIP
AT "1
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN CON'
PLFTED.
PERMIT FEE PAID ;_ . '.................TIGARD SANITARY '.ISTRICT
By
.arw�a
CONNECTION INSPECTED AND APPROVED
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