12025 SW BURLHEIGHTS STREET-1 %W W fir-i 'w6J_
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120)') SW fAlJR1,HFTGHTS STREET
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Addresa � v Permit No. r G
Name of O--cupant_____ Fo mit charge
Connection fee
Paid by
Date connected
Type of Building Inspec'.ioa
Service Rate _ PAid by _-Date 2
Contractor Assessment Paid
Size of :annection
i
PERMIT TO CONNECT
Tigard. Sanitary District
PERMIT Nn 1064 DATE
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SAKITART DISTfi'^T _ A
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBEII PREMISES UNTIL,CON-
NECTION IS MADE AND INSPECTION OF CONNECI(ON HAS BEEN COM-
PLETED.
PERMIT FEE: PAID fit_ . ............... .......... TIGARD SANITARY DISTP; ;T
By
CONNECTION INSPECTED AND APPROVED
liato Superintendent