12830 SW GRANT AVENUE-1 "y+
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''�daress/„� �j0 �ll� La-►s ___ Permit No.
Permit. charge
Owner Connection fee
Paid by��
Type of building Date connect_�d
Service Rate _ Inspection fee
Contractor Paid by _Date.1 "7_�.
Size of -onnection Assessment laid
/2 G
PERMIT TO CONNE ;T
Tigard Sanitary District
PERMIT N9 1072 DATE
rr[cnlrr LF (JYEN 'ro r ; ,� _ '4 J
OF
TO CONNECTTO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT ___ --— ---- ------_ ——_ _
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PRF,MISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT F'FE PAID ;. .`. . .............................'r1.,A[tD S..^.NITARY DISTRICT Gr c)
By
.re.
CONN[sCTION INSPECTED AND APPROVED
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