12015 SW NORTH DAKOTA STREET ]20.15 STN NORTI' DAKOTA STREET
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT No 1123 DATE
P
PERMIT IS IxIVEN TO
OF
TO CONNECT A r....
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DF—SCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $.... ............................TIUARD SANITARY DISTRICT
By J
CONNECTION INSPECTED AND APPROVED
Date Superintendent
i
Address l �� I 7, . - , a Permit No.
Permit charge
Owner _ Connection fee _
Paid by � ^��
Type of Building___ _4 _ Date connected`
Service Rate_ Inspection fee
Contractor y�i _( �u��t Paid
Size of connection- L/ " _, Assessments_ _ Paid