11585 SW MANZANITA STREET 11585 SW MANLANTTA STREET
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AddresslMRJYJANTA__,_._ Permit No._/ 3 —_
Name of Occupant_______----- Permit charge
Connection fee
Paid by_ ----
Date connected_ �.0 _ ►ems--------.-_---
Type of Building Lam_ ____ -__ ______ Inspection fee_
Service Bate_ — Paid by
Contractor _ —_.- __- Assessment
Size of connection_.
a
PERMIT T4 CONNECT
Tigard Sanitary District
97:x5'
PERMIT N? 1.023 DATE '
PERMIT IS GIVEN TO
of -
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST HE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS M,','tE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $e..................................TIGARD SANITARY L RICT
A ' By
CONNECTION INSPECTED AND APPROVED
-
Date _ _
Suverintendent