12525 SW MAIN STREET 12525 SW MAIN STREET
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Address �- J .Z l �ci/ Permit No.
Name of Occupants �� �1 Permit charge _
n//) /V9 Connection fee t' d" ,�•�.,� d k
Nate connected
Type of Building---___,_____._ 1nrpection fee
Service Rate Paid by _ Date-
Contractor .------
ateContractor ,______ Assessment Paid
Size of connection.______._. .�.__.------___
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PER1v T ' TO CONNECT
Tigard Sanitary District
PERMIT N° 680 DATE 'S
PERMIT 18 GIVEN TOt.,.r :�• ls' x y t Jb
TO CONNECT A rli`
TO THE SYSTEM OF TIGARD SANI 'ARY f1IETRICT
AT IV •<
THIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION (S MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
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PERMIT FEE PAID ...... ....:......................TIGARD SANITARY DISTRICT
By
q-ONNECTION INSPECTED AWT', APPROVED
TDAte Superintendent --- ��