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Addrese��`�Dy��f/A�htR tsr_1rLS_ Permit No..
Name of Occupent_ _ Permit charge
Connection fee
Paid by _
Date connected 7 _
Type of Building.` _ Inspection
Service Rate_ Paid by ___Date
Contractor Assessment Paid
Size of connection __
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PERMIT TO CONNECT
Tigard Sanitary District F �'
.3
PERMIT No 931 DATE
PFRWT IS GIVEN TO -4 } ►
OFTO CONNECT A
TO TN:: SYSTEM OF TIGARD SANITARY DISTRICP
AT
THIS PERMIT MUST BE POSTED ON THE DEArRIBED PREMISES UNTIL CON-
NECTION IS MAT'/E AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $..... .:..............._...........TIGAR: oAKITARY DISTRICT
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CONNECTION INSPECTED AND APPROVED
bate 8uperh tendent