11545 SW MANZANITA STREET IA A YY 7lIR � r11E1 � !fit �1!
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Address Permit No.
Name of Occupant __ Permit charge
------ Connection fee .2 X'0
Paid by__
Date connected --/
Type of Building Inspection feo_,/0
Service Rate__ _____ Paid by Date
ContractorAssessment_- Paid
Size of connection
IA 71w w7A MW
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 1029 DATE
PERMIT Ifi GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISF UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS LEN COM-
PLETED.
PERMIT FEE PAID $..... .............)..............TIGARD SANITARY DISTRICT
C/ V By
q6I -
A
CONNECTION INSPECTED AND APPROVED
-- Date �� Superintendent