11120 SW 119TH AVENUE i.
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Address,///-2.0-,AW Permit No.2sf�—,
Name of Occupant_. Permit charge
Correction fee__
Paid by
Date connected 1 G 7
Type of BuildingInspection
Service Rate Paid by _. Date` _
Contractor— Assessment_ __Paid
Size of connection
PERMIT TO CONFECT
Tigard Sanitary District
PERMIT N? 954 DATE - '
PERMIT IS GIVEN TO I ---_._ �- ` `
OF
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TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY I1ISTRICT
AT
THIS PTIRMIT MUST BE POSTED ON T1IE DESCRIBED PREMISES UNTIL CON-
NECTIO.J IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID 1•••••-"•• �••••J •..........TIGARD SANITARY DISTRICT
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CONNECTION INSPECTED AND APPROVED
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Date �- Superintendent
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