12010 SW NORTH DAKOTA STREET 12010 SW N)RTH DAKOTA STPFET
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N? 1@52 DATE
PERMIT 18 GIVEN TO
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OF
TO CONNECT A - —_- —_----,-- -
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS SEEN COM-
PLETED.
PERMIT FEE PAID TIGARD SANITARY DISTRICT
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C0NNEC'fI0N INSPECTED AND APPROVED
Date Superintendent
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Addressa �-tx, Permit No.
Name of Occupant_ _— Permit charge
Connection fee
- -- aid
Date connected
Type of Building _ Inspection fee_,______
Service Rate___-- _.- - -. Paid by -- __-__ -- -Date //_/4(- _� 7
Contractor Assessment Paid
Size of connection
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