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Address SGIJ_ l��•cs.�.rr �/1� Permit No. G��
Name of 'occupant Permit charge
---—��, � ,'r D�-;►�y��F e' ' ` 4`"cam -�►... c Cle ----
--- — —`-- __ _ Paid by
-- - Date connected
Type of Building _.��.t,y Inspection fPe _Z
Service Rate - Paid b'_"' ft'`r��
Contractor
------�--- Assessment Paid„
Size of co ection /6l ri \.ollt_�
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APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration c,f the sewer service connection by the
Tigard Sanitary District, to abide by and comply with the ordinances, iegulations and rules o; the Dist-
rict presently in etfect or hereinafter enacted and to pay sewer service charges as the same may be im-
posed fro,n time to time when due and before such charges become delinquent.
I fully understand that all unpaid sewer service charges become a lien upon the
property 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
TIGABD SAPIITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon
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to
PEPMIT TO CONNECT
Tigard. Sanitary District
PERMIT N9 652 DATE
r'or
PERMIT IS G{Il%N .4:;—C 7 r.' .(I.-<!1%
of 7 /
,/� ;,�G �.w. r''S
TO CONNECT A . .v��.!_� ,^ Y `/c.. �( 1 1
A.¢ A
TO THE.SYSTE R/OF TIGiARD SA1TA� DISTRICT
AT Pr,tk_4 r . til L
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NEC'iION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID . ........1'1GARD SANITARY DISTRICT
By
CONNEL'TION INSPECTED AND APPROVED
IXte ntendent