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Addres,3 Permit No.
Name of Occupant Permit charge
Connection fee
Paid by_
- ------ Date connected -le
Tyi,.q of Building Inspection fee
Service Rate Paid by
Date
Contractor Asrwsment— Paid
Size of connection
�` lfoll � A Ra IEd� 11R a �
PERMIT TO CONNECT
Tigard Sanitary District
'PERMIT N9 914 DATE
PERMIT IS GIVEN TO ,t,Z-- �J k <.� a•..
i
OF
TO CONNECT A
TO THE SYSTEM Or TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DE9CRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN CO1Vl-
PLETED.
PERMIT FEE PAID a. ..... .........................TIGARD SANITARY DISTRICT
By
CONNEC'TI N INSPECTED AND APPROVED
Date
1, a