8940 SW BURNHAM STREET-1 f
a
r
CD
1
8940 SW BURNHAM STREOr
4ddress (�_—� w.t����.y� Permit No.
Name of OOcccup�ant/__� � Permit charge.�_4_(�Lj�
--- --- ----- Paid by
----- �——_ Date connected
Type of Building_ Inspection
Service Rate_ Paid by ___ Date
Contractor Assessment_ � . p 6
Y
Size of connection c a� �_ t.,{
t
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, 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.
I fully understand that all unpaid sewer service charges become a lien upon the
property served as stipulated in ,-). R. S, 224.220.
Connections to the District's system mus-. be made by bonded contractors and/or
bonded and licensed plumbers.
Owner
APPROVED BY
Superintendent
v
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon