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AMULMUM
INSPECTION NOTICE
City o;'T;gard Bvildin4 Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of lnsp,,-ction
Date Requested 7-
Address
Owner Lot
Builder
The following Building Code deficiencies are required to be corrected:
Presented to Approved
Inspector Disapt roved
Dbte
CALL FOR REINSTMON
❑ YES 10 NO
OWN
Addre,s / �.,5��:. .� Permit No. - 0
Permit charge,_
Owner_ , � .�� ���K_�� �r�� Connection fee- 31SOc)
Pa j d by_
Type of building ��-- Date connected_
Service rate Inspection fee_ J 5 ° `'
Contractor Paid by__ Date.
Size of connection �� Assessment Paid
PERMIT TO CONNECT .�
Tigard Sanitary DistrictS�
PERMIT N? 1.390 DATE - - ----
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT c
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREM?GES 7FTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION U 43 BEEN COM-
PLETED.
PEP'.:,: 'v.E PAID $. . ..........................TIGARD SANITARY DISTRICT
By
.tires I�rwiriw+
CONNECTION INSPECTED AND APPROVED
Date Superintendent