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8965 SW COMMERCIAL S'T'REET
Address ___ I _. (_-�n�n�rLpJL[ Permit No. I RIO
Name of Occupant__ _._ }P�rmit charge
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- -�� — ---- C aftftee4im!rfee 3 0,
--- --- ---- ----- Paid
- -- --------- - -- - Date connected-------- -=� ----
Type of Building - Inspection fee
Service HateDate
Paid by __ ---------- -
Contractor __. Assessment (j raid
Size of connection -__�y1`____
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APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer service connection by the
Tigard Sanitary District, to al, de by and comply with the ordinances, regulations and rules of the Dist-
rict presently in effect or hereinafter enacted and to pay sewer service charger as the same may be im-
posed from time to lime when due and before, such charges become delinquent.
I fully understand that all unpaid sewer service charges become a lien upon the
property served c-s 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.
APPROVED BY Owner
Superintendent
TIGARD SANITARY DISTRICT'
8841 S. W. Commercial St.
Tigard, Oregon
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