11970 SW BURLHEIGHTS STREET.•,. 1•
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Address// Permit
Name of Occupant Permit charge
Connection fee
Paid by
Date connected 7
Type of Build4ng Inspection fee-
Service Rate Paid by Date
Contractor Assessment—___ __Paid
Size ; connection-_
PERMIT TO CONNECT
Tigard. Sanitary District
PERMIT N? 940 DATa
PERMIT IS GIVEN TO
OF ) I l
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TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRDCT
AT__�s
0 MOW
T1113 PERMIT MUST BE POSTED ON THE DESCRIBED PREM1E10
NECTION IS MADE AND INSPECTION OF CONNEMION HAS BEEN COM-
PLETED.
PERMIT FEE PAID a.•. .............................1'IGARD SANITART DISTRICT
By
CONNECTION INSPECTED AND APPROVED
__ —_--- Date Superintendent T---_----
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