8931 SW BURNHAM STREET�1
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31 SW BURNHAM STREET
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Address"-3-/ Pear ii No.
Name of OecupAnt _.______._ Permit charge
Paid by
Date connected
Type of Building. W- Ir-pection fee.
Service Rate_ Paid Paid by Date
Contractor 4W",k-k Assessment Paid
Size of connection
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 orc�nances, regulations and rules of the Dist-
rict presently in effect or hereinafter enacted and to pay sewer service charges as the same may Le im-
posed frorr time to time when due and before such charges become delinquent.
I tally understand that all unpaid sewer servica charges become a lien upon the
property nerved as stipulated in O. R. S. 224.22.0.
Connections to the District's system murit be made by bonded contractors and;'or
bonded and licensed plumbers.
--- Owner
APPROVED BY
Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commerci:jl St.
Tigard, Oregon
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