10240 SW BROOKSIDE PLACE � II
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4• SW BROOKSIDE PLACE
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Address /000 5. w permit No. I��
Name of Occupant /I;e"1.4,c'o /+� 1`'i� SOti' r CC.p i ermit charge .Z _
Connection fee
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- — Date connected 1-/,��3
Type of Building Jt�� '/nf 4,t r
Inspection fee
Service Hate
— _ Paid by Date %' i' l' _
Contractor .T4Mr Assessment
Paid
Size of connection
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N�) 719
DATE
;
PFfiMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADF AND INSPECTION OF
PLETED, CONNECTION HAS BEEN COM-
PF,RM)f FEE PAID
$-••..;�.....••................_TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED l4
Date -
a
3uperint dent
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