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Address /-I S TS--r/idetom t.Q4 fir. Permit No. 9esr
14,1171r. of (jr c uEi�tu1 _ PeImit charge
Connection fee
Paid by
Date connected /a - 34 -4-6 _, _
Type cf Building__________ Inspection fee
Service Rate _ Paid by Date________
Contractor_ — Assessment—_____—Paid
Size of connection
PERMIT TO CONNECT
Tigard Sanitary District
Nm
PERMIT 'N9 9 ( 5 DATE
PFRIIIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT i
AT
THIS PERMIT MUST BF POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $_ . ............................TIGARD SANITARY DISTRICT
By�
INN?CTION INSPECTED AND APPROVED
6 p . /t r
.Date _�_ �—� �^_�.6 Superintendent