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2 .�o 'O J C l C�d�S�(/'c! A` Permit No. g I
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Name of Oecapant ___ Permit crorge
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Connection ! �e
Paid by ,
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. T)lti, ;;onnected.�,
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Type of Binding ` _`' Inspection fee 6 ! _
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Service Rate __ Paid by(.4it" t t-t�.P�l�Date
Contractor,_---___ _ _ AsAow;..,ent Paid /
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Size of connection
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PERMIT TO CONNECT
Tigard San t.:a ry Dista ict
PERMIT N? 681 DATE -3
PEPAIIT IS GIVEN TO
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OF 1 1`f; J
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
THIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION 1S MADE AND L78PECTION OF CONNECTION HAS BEEN COM-
PLETED,
0Y
PERMIT FEE PAID $.........).......................TIGARD SANITARY DISTRICT
CONNECTION INSPECTED AND APPROVED
Date __._. Su ent _