11195 SW 119TH AVENUE 11195 SW 119TH AVENUE
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PERMIT TO CONNECT ab
Tigard Sanitary District
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PERMIT Ni) 9, 63 DATE
PERMrr IS GIVEN To
OF
TO CONNECTTO THE SYSTEM OF TIGARD SANITARY DISTRICT
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THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION TIAS BEEN COM-
PLETED.
PERMIT FEE PAID $.... .....:......................TIGARD SANITARY DISTRICT
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CONNECTION INSPECTED AND APPROVED
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Address///S�C���_ '—---- Permit No. --
Name of Occupant____ _ Permit cb arge
Connection fee_
Paid by ___
Date connected___ �.� " G 7
Type of Building _ Inspection fee _
Service Rate Paid by Date.
Con;Tactor------- ____- Assessment__-- , _ Paid _
Size of connect'oII