10260 SW BROOKSIDE PLACE I
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Add reea �QAr--TfA Permit No.
Name of Occupant _ Permit charge
Connection fee
Paid by ----_
- Date connected - /O - 6
Type of Building Inspection fee
Service RetePaid by Date _
Contractor
- -----_---__.__ Assessment.__ - Paid
Size of connection
PERM7LT TO CONNECT
Tigard Sanitary Distr;ct �
PERMIT N9 913
DATE
PERMIT 1S GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST HE POSTED ON Till;DESCRIBED PRFM'SFS UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $.... ............................TIGARD SANITARY DISTRICT
Ry
7
CONNECTION INSPECTED AND API'ROVFD
02 0
---mate - - _—T�p�'intenn en`t --