12515 SW KAREN STREET 12515 SW KAREN STREET
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Address Permit Noe_,,,
Permit charge_ -;2
_ Connection foe_
Uwner� �.
Paid by_____— -_-
Date connected ?�
Type of building
Service rate
Inspection fee 1411'
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Contractor Paid by.___ -Date .
Size of connection yip .Assessment_ Paid
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PERMIT TO U."UN ECT o� 11 S 7 ry1
Tigard Sanita-ry District
PERMIT N9 1290 DAxe
PERMIT IS GIVEN TO
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OF
TO CONNIICT A r'
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
"AIS PERMIT MUST III POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED,
PERMIT FEE PAID s.... - .. ;...�r...h'.....TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
Date SupWntendent