9115 SW BURNHAM STREET l e I
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT leu 1380 DATE
PI?R.M1Ii'T I8 GIVEN 7C0
OF ----
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITAkY DISTRICT
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T1418 PERMIT MUST BE POSTIA) ON THE DF9CRIRFD PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED. y
PERMIT FEE: PAID #....f." ..�................TIGARD SANITARY DISTRICT
CONNECTION INSPECTED AND APPROVED
Date _ Superinten—aent
I
Address_. � .. Permit No..-- —.------- ----
Name of Occupant_. Permit charge
Paid by___
Date connected :►� G �____
Type of Building_ Inspection fee___-
Service Rate
�- ( �- Paid by
Contractor. kr~ - —" t Assessment- � Paid�_ S�
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 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.
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 _
� 1
Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon
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