12760 SW PACIFIC HIGHWAY §--- -
1.2760 SW PACIFIC HIGHWAY
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Address A, ��j e UJi �pC s t. Permit No.
Name of Occupant �,�,��e�. dtey'CD Permit charge.-__
Connection fee
---- --— - - Paid
Date connected./%/�� r- `
Type of Buildinq — Inspric lon fee
Service Rate 'Sia Paid by _ Date_______-
Contractor _ _ Assessment__.
Size of connection
_;�:f. r ►� i�'►�'.''n'",� �1 �j x.70 - ��d d
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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 hF:einafter enacted and to pay sewer service charges an the same may be im-
posed from time to time when due and before such charges become delinquent.
I tu:ly 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 plumbe.s.
Owner
APPROVED BY i1
Superintendent
TIGARD SANITARY DISTRJCT
8841 S.W. Commercial St.
Tigard, Oregon