11995 SW KATHERINE STREET-1 w, Y
11995 SW KATHERINE STREET
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A d d r ei s 9 Af j Permit Nc.
Name of Occupant-_._____ Permit charge
Connection fee 2, C
Paid
D-ate connected
Type of build:nrl Inspection fee
Service Rate Paid by Da,e
C intractor Assessment Paid
Size of nonnection
PERMIT TO CONNECT
Tigard. Sanitary District
PERMIT 979 DATE r ,
PCRb111 IN GIVEN TO
OF
TO CONNECT A
I'^Tiff, SYSTEM OF TIGARD SAN01ARY DISTRICT ~�^
AT
T(II` PERMIT '.MUST BE POSTED On THE DF9CRIBED PREMIERS UNTIL CON-
NECIION i8 MADE AND INBPI:
PLETEI"r, C""ION OF CONNEC TON HAS BEEN C.OM-
PF,RM1[IT FEE "AID $....__...........................I GARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
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- __� Date