8935 SW BURNHAM STREET-1 ..a,W���,�..r+,ia�:�'e+ur�+�+.wnaw.�w.::�:,«,uw�uK•�i++dia►Yw+�Wiw �k+�•Y.�tr � '
1 ,
Co
kD
I w
In
LO
W
G
w�
L
8935 SW BRUNHAM STREET __
A i
Address?-Y3j.._ Permit No. .
Name of Occupant_-_ Permit charge
C� �n
-- --- - --- -- --- Pard by
�
Date connected �- 1,_— •.� �
Type of Building Inspection fee
Service Rate ,�(_J Q Paid by
Contractor "'�-tc�W —__ Assessment.��e" d Paid
Size of connection 1 � p
i
APPLICA'T'ION FOR SEWER SERVICE
The undersigned agrees, in consideration of +he sewer service connrction by the
Tigard Sanitary District, to abide by and comply with the ordinances, regulations and rul !s of the Dist-
rict presently in effect or hereinafter enacted and to pay sewer service charges as the se ne may be im-
posed from time to time when clue an: before such charges become delinquent.
1 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
TIGARD SANITARY DISTRICT
6841 S. W. Commercia: St.
Tigard, Oregon
17 +�