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Address��p ��G�/�,�-���� Pel nut No. .-
Name of Occupant Permit charge
Connection fee. _
-- �_ Paid by---- — --
Date connected
Type of Building dol,/ j.fl V " Inspection fee
service Rate----__._y�-_G'l� - Paid by - _ -_-- -----Date--
Contractor. - _ Assessment Paid
Size of connection
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APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer service connection by the
Tigard Sanitary District, to abid-4 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 �m-
posed from time to time when due and before such charges become delinquent.
I fully understand that all unpaid sewer service charges bec(,me a lien upon the
property served as stipulated in O. R. S. 224.220.
Con nectio- to the District's system raust be made by bonded contractors and,"or
bonded and licensed plumbers.
Owner
APPROVED BY
Sut)erintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon
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