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Address � ��5, ``(1J inn ,r Permit No. We-
Permit charge
Owner Connection feeSZ'_ A 4
Paid by
Type of Building 4F 4,eG-,Lae Date connected
Service Rate_ Inspection
,,fee /C
Contractor °���>[ � ,� � 1) Paid by l/� Date "' 6^
Size of connection l! Assessment Paid
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 1203 DATE ____ ____
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTR'-CT
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AT ,�-
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES 13NTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID E. x .''3"""""-•••.............FIGALD SANITARY DISTRICT
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CONNECTION INSPECTED AND APPROVED
--------- Date Supertnten�t