10455 SW JOHNSON STREET :0955 SW JOHNSON STREE`,'
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INSPECTION NOTICE I
City of Tigard Building Department
12420 S.W. Main St,
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection
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Date Requested�_ f � – _ Time , A.V �--P.M.
Address _ / it GJ :t;,– �_ .?�' _�.rZ. 'Jr ----Permit # �
' _ Lot #
Owner_-- '��. —_.-- —
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no following riding Code Ieficier cies me required to be corrected:
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Presented to ___..__ _ proved
Inspector L] Disappruved
Date
(., I,L 1,"OR REINSPRY'TION
[ I YES ❑ NO
PERmn' TO CONNECT
Tigard Sani Laxy DistricttV,�
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520 DATE
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PERMIT .a GIVEN TO,, �•..• 4 .• tN►-�S —
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TO CONNECT A
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TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISED UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETr'D.
FERMIT FEE PP. #... .:......... ...............X'IGARD SANITARY DISTRICT
By
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Co,lNECTION INSPECTED AND APPROVED
�....------__-Date_._ Superintendent - ---
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Address 10455 S.W. JohnsonPermit No ., 1520
Permit
Owner John Cook _ Connecticri fee 300.00
Paid by__..._John_Cook ____._._.__._..._ ...
Type of building lies. _ Date connec l,ed8/16/71
Service rate Inspection fee_ 25,00
Contractor_ _r Paid .,,y nage
Size of connection Assessment Paid