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Address Z4Zgt,�,3y&,LC rcej 7— Permit No. Zoo /
Name of Ot;cupant___ _ Permit ch;srge 2
Connectionfee ASO
Pa,u ::y Ar.til hD PLVMd1N 6 _
Date connected $'J !f
Type,;)f Buildinq_Rlu _ Inspection fee /o Q=
Servi^e Rate_ Paid by.4LLl Eo P'LM Q Date t-J y
Contractor A L F k w w p A R Assessment Paid
Size of connection_
Tigard Sanitary District
PERMIT Nc) 1.001 DATE��' -,..�y 7
PEE 311T IS GIVEN TO jol ly pd J�dl!/C, .--/;>
TO CONNECT A ff oy—_-,/� �—
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON TzIE DESCRIBED PREMISES UNTIL CON-
NF.C3'ION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID ...................TIGARD SANITARY DIS.RICT
By
4, r � .
CONNECTION INSPECTED AND APPROVED
Date Surerinterdent
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1
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