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Permit
Name of Occul.)ant-_____ Permit charge
Faid by
Date connected j
Type of Building_ Inspection fee
Service Rate_ V
Paid. by Date-----
Contractor Assessment.- -Paid
Size of corintiction- A/
APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer service connection by the
Tigard Sanitary District, tc abide by and comply with the ordinances, regulations and rules of the Dist-
rict presently in effect or hereinafter enacted and to pay sewer service charges as the same may be im-
posed from time to time when due and before such charges become delinquent.
Y fully understand that all unpai3 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
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TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, O: ?goi:
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