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PERMIT TO CONNECT
Tigard Sanitary DisIL-rict
PERMIT N° 9( DATIC.�__t_
PERMIT 1S GIVEN TO
OF
TO CONNECT A.
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS P!;RM1T MUST BE POSTE J ON THE DE9C1tIBFD ellEMI3ES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BFEN COM-
PLETED.
PERMIT FEE PAID $...... :...........................TIGARD SANITARY VISTRICT
BY
CONNECTION INSPECTED AND APPROVED
Date -- — &ipeclnMadent�
WWWMMN N
Address N ,+ J 9rN _ Permit No. 1
Name of Occupant` __ Permit
- --- --- ----- Connection fee
—-- ----- -------- -- - Paid by—_ �
- - - Date connected
Type of Building_______ -
- Inspection fee
Service Rete_____--- --- y - Date
-..�-- - -- -- - Paid b
Contractor-_ Assessment
- --------- - -- --Paid
Size of connection