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PERMIT TO CONNECT
City of Tigard
Permit Vo 503
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PERMIT IS GIVEN To__ �� _.._
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TO CONNECT A -
TO THE SYSTEM OF CITY OF TIGARDAT-
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THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON•
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED. M.
PERMIT FEP PAID $ __CITY OF 71GARD
BY -
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CONNECTION INSPECTED AND APPROVED
Date Superintendent
Address., � `�if; r�"� (9-1-Permit No.-- A,..q,
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Name of Occupant _ �i4rh�.9�� Permit charge uc�nC
Connection fee—
Paid
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Date connected
Type of Building f CJ/,azz— c I.nspectim fee
-
Service Rate-_-- 2— -,C' Paid by �rGG; /�cr iC✓ Ditto r S
Contractor_ , %i /�'IEJ. Zel, /�-'I- Assv9sm)nt__ 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 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.
I fully understand that all unpaid sewer service charges become a lien upon the
property served as stipulated in O. R. S. 224.220.
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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. Commercial St.
-•I Tigard, Oregon
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