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. 2550 SW BROOKSIDE AVENUE
Address /a? .ST •�/�/, CJ/DE fi��'•Permit No. X"
Name of Occupai►t ►'1'_ T o S
---- Permit charge
Ir
,-^ Connection fee S-4 f
/a 3�— io 3(c u.•-a,-�t.s.. ,.a'- '? Paid by
Date connected
Tvpe of Building Inspection fee f
Service Fate_ - Paid by
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__ c ZDate f �J
Contractor_ 1/4!LL-
Assessment Paid
Size of connection !� "
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PERMIT Tv CONNECT
Tigard Sanitary District
PERMIT N9 786 DATM s
PERMIT IF GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITART DISTRICT
AT
THIS PERMIT MIST BE POSTED ON THE DF9CRIBED PREM Bks UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS EF.EN COM-
PLETED.
PERMIT FEE PAID 0.... ..... .. ............... ....TI(iVtArl5ii-VtAR!'D18TRICT
BY
CONNECTION INSPECTED AND APPROVED
-
Superir�dent