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12625 SW GRANT AVENUE
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PERMIT TO :2,0NNECT
Tigard Sanitary District
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PERMIT Sr l 644
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PERMIT 1S GIVEN TO - Jv
OF
TO CONNECT A
TO THE SYSTEM OF TYGARD SANITARY DISTRICT
THiiS PERMIT MUST BE POSTED ON THE DEScmirF.I`PuEMISES UNTIE.CON-
NEC:TION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLFTED.
PERMIT FEE PAID $....................................TIGARD SANITARY DISTRICT
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CONNECTION 1'NSPECTED AND -;(`PROVED r
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Tax Lot 2 91 -2 BC 400 23-10 North Tigirdvil?a Addn
Assesiment. 630.22
Lateral
Paid in full 5-2-6
Address Permit No,
Name of Occur.int (, L7/ Permit charge
Connection fee r !sem
-- _— _-__-- Paid by— --
— _ Date connected &VA "_
Type o1 Building _- Inspection _—
Service Rate 0 6 P;-.id by Date._
Contractor _ _ Assessment_ kn� _Paid A-1,13
O'
Size of connection__._..__jI__ _ _