11605 SW MANZANITA STREET I r
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Address 1144j'SPermit No. ZO C
A-A-N-khoulrA
Name of Occupant___.________ Permit charge—2
Connection fee -2S-& —
Paid by-ACMlCVFyA-,,A PLyma,,Y
Date connected .?9-G-7
Type of Building Inspection fee
Service Rate--- Paid by
Contractor--,;V L- Asspsament-- Paid
-
Size of connection
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 1004 DATE '/,`'�
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARP SANITARY DISTRICT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
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PERMIT FEE PAID ...............................TIGARD SANITARY DISTRr 'T
By
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CONNECTION INSPECTED AND APPROVED
T Date Superintendent �M