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Address-/ / Permit No.
-37
Name of Occupant ga'j- Permit charge 142
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Paid by,
Date colected—7 — 7 —
Type of Building Inspection fee— Y41
—1d
SeTVjCP Rate—*Tt--6 2.6 Paid by, ate
Contractor! Assesdinent Paid
Size of con 4
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APPLICATION FOR SEWER SERVICE
The undersigned sgrees, 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 a zacted and to pay sewer service charges as the same may be im-
posed from time to time when due ana before such charges become delinquent.
I fully understand that all unpaid sewer service charges become a lien upon the
property served as stipulated in O. R. S. 224.220.
Conr ections to the Distric!'- system mu be made by bonded contractors and/or
bonded and licensed plumbers,
Owner
APPROVED BY
71-1
A— --
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Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon