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9505 SW COMMERCIAL STRUT
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Address S n!!� (4-)qIAJ4 C I Permit No.
Name of Occupant— Permit charge
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Paid by,,/P-144 �D
Date connected - 3
Type of Building � - Impaction fee _
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Service Hate Z _. )laid by nate
C antractor C ' t �o�'��i _ Assessment_ Paid
Size of co�neetton--L ea,y�c
APPLICATION FOR SEWER SERVICE
The undersigne,' 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 preser,,'y in effect or hereinafter enacted and to pay sewer service charges as the same may be im-
posed frc 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 C. R. S. 224.220.
Connections to the District's system must be made by bnnd4 contractors and/or
bended anJ ,:cen..ed plumbers.
Owner
APPROVED BY
Superintendont
TIGARD SANITARY DISTRICT
6841 S. W. Co-nmercial St.
Tigard, Gregon
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 653 DAT1I
V R,IIIT IS GIVEN TO
OF
TO CONNECT A
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TO THE SYSTEM OF TIGARD SANITARY DISTRICT
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THIS PERMIT MUST BE POSTED ON THE DESCRIBED P$EMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
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PERMIT FEE PAID $... ,#.......... ,,, ,TIG{ARD SANITARY 1DISTRICT
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CONNF,UTION INSPECTED AND .tllf''ROVED
Date Sup ndent
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