12020 SW 95TH AVENUE WIWI
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PEWILT TO CONNECT
Tigard Sanitary District
PERMIT N° 655 DA IN
P-RMIT IS GIVEN TO,OF
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TO CONNECT A �
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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THIS PERMIT MUST BE POSTED ON 'ruE DI 4CRIBED PREMISES UNTIL C.ON-
NECTION IS MADE AND INSPECTION OF CCNfk,ECTION HAS BEEN COM-
PLETED. r
PERMIT FEE PAID ...' ...... ...........TIGARD.(iQNJTARY DISTRICT
By ( ,��� . o,,.w
CONNECTION INSPECTED AND ,IPIIROVED
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Address z 2k;L0_ aw• qS~ Permit N.). r
Name of Occupant Permit ciaZrge_
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Paid by
Late connected-
Type
onnected_Type of Building_ I.b1 `�'- Inspection fee_ ,
Service Rate -- J'/ Paid by Date_�Cr���
Contractor Avt11GC "j'/
Aswssmeat Paid
Size of c ection �- r
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APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sbiver service connection by the
Tigard Sanitary District, to abide by and comply with the ordinances, regulations and rules of the Dist-
rict prrisently in affect or hereinafter enacted and to pay sewer service charges as the same may bo im-
posed from time to time when due and before such charges become delinquent.
I fully understand that all unpaid sewer service chargeb become a iien 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
Superintendent
TIGARD SANITARY DISTRICT
8841 S.W. Commf-rcial St.
Tigard, Oregon
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