11650 SW 121ST AVENUE i•,
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 371 DATE - -
PERMIT IS GIVEN TO
OF
TO CONNECT A ------
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THF DESCRIBED PREMISES UNTIL CON-
VECTION IS MARE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID t.... .:..........................TIGARD SANITf!RY DISTRICT
B7
CONNECTION INSPECTED AND API'R(I%'ED
V
_bate __.. ------Superlatendent --------.�.
--- - --
IWO
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Address �� t�- _ _ _ %1 � � Permit No.-?
Name of Occupant Permit charce
Connection fee
Paid
Date corrected lo -19- 67
Type of Building Inspection fee_-_
Snrvice Rate.. _..__-_.- Paid by , _Date
Contrcctor._----. - -_ _ Assessment - _----_--._ _Paid__------_-_.-
Size of connection _