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Addiess
Permit No.
Name of Occupant_ gOPermit charge--
;Qua"
harge_-
VII Paid by-----
Date connected /
Type of Building al-M Inspection fee
Service Rate_(/ ----- — Paid by rate__,__
Contractor d?9 rd Assessment4,�C-L , Paid --
Size of connection
APPLICA" ION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer service connection by the
Tigard Sanitazy District, to abide by and comply with the ordinances, regulations and rule- :,t the Dist-
rict presently in effect or hereinafter Pnacted ancl, 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 -arved as stipulated in O. Ii. S. 224.220.
Connections to the District's system must be made by bonded contractors and/or
bonded and L'censed plumbers
Owner -------
APPROVED BY
Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial ct.
Tigard, Oregon
_ 1
(Name
Permit No.of Occupant ``,� f �� n.� Permit charge
Connection fee
- -------- _ Paid by --- ---- --- -----
- -- - Date connected
Type of Building_ --- —___
Inspection fee
Service Rate at� L� Paid by _ Date
(:ontractoY Assessment.--_ _- Paid
it
Size of connection �.
�/�7 /o7fXc
APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer service connection by tL4
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 chatjes as the fume may be im-
posed f-om ume 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. 224.2.20.
Connections to the District's system mutt be made by bonded contractors and/or
bonded and licensed plumbers.
APPR Ep BY
Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon