11995 SW 119TH AVENUE MMT-11' U LM
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11995 SW 119TH AVENUE --
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PERMIT TO CONNECT
Tigard Sanitary District V`1
PERMIT N9 9 4 2 DATE ----=---- .
PERMIT IS GIVEN TO ... __
or
TO CONNECT A r u
TO THE SYSTEM OF TIGARD SANI'F.ARY DISTRICT
AT {
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $-.. .........._.. .............TIGARD SANITAR-f DISTRICT
By
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CONNECT!t)N INSPECTRI) AND APPROV2D
Date -- Superintendent
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Address Ztf Permit No.
Name of Occupant_ Permit charge
- _ Connecti_ i fee
Paid by___ _
- - Date conne&ed_.�_
Tvpe of Building Inspection fee
Service Rate__ _ Paid by Date.`_
Contractor Assessment Paid
Size of connection
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