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12570 SW BROOKSIDE AVENUE
Address _ - I� SIN• �i��ct-sih� ASF Permit No.
Name of Occupant C�9l�e �ANSj,f'n�J permit charge
Connection fee ' r�P
--- ---- -- Paid bY,_.._.`
Date con: r.-ted ��, /b S—
Type of Building �� 5/pe < < Inspection fee___l'
Service Rate Paid by / /lt-f Date J4
Contractor— 11Awcr l F/' Assessment Paid
Size of connection // r
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 i S 5 DATE
PFRMIT 1S GIVEN TO
OF
TO CONJwZCT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID ..:'`............................TIGARD ,bkXt'1'A1tTDISTRICT
By
CONNECTION 1t:n APPROVED
or
TDate Su7dent