9265 SW CENTER STREET 1 '
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9265 SW CENTER STREET
Address (114&e _ Permit No. A
Name of Occupant Permit charge
Connection feed 4.
-- Paid b7 �, Y r,46;i
Date connected q4u., -- /
Type of Building Inspection fee
Service Rnte-9 ,42 () Paid by, DnteV
ContractorAssessment _Paid
Sias of connection 1�
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APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer service connection by the
Tigard Sanitary District, to abide by and comply with the ordinances, regu-llations and rules of the Dist-
ric., presently in effect or hereinafter enacted and to pay sewer service charges as the same may be im-
posed from tira tc time when due and before such charges become delinquent.
I fully understand that all unpaid sewer service charges become a lien upon the
prop,rty served as stipulated in O. R. S. 224.220.
Connections to the District's system must be made by bonded contractors and/or
bonded and licensed plumbers.
Owner —____....
APPROVED BY
Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon iti:;