9075 SW BURNHAM STREET-1 77 '
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Addy( L� ---`� �? Permit No.� �L>�
Name n' Occupant_ _ Permit charge ____�•_,�_�_
52
---— Paid by
--- - ---- — --- Date connected
Type of Building _ Inspection fee____
Service Rate-_ _ N Paid by Date
Contractork-- - _ Assessment..3 1.i!�_O__Paid
Size of connection _
APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewe- service connection by the
Tigsrd 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 1,-- upon the
property served as stipulated in O. R. S. 224.220.
Connections to the District's system muet be Wade by bonded contractors and/or
bonded and licensed plumbers.
----- ----- --- Owner
APPROWA) BY
Superintendent
TIGARD SANITARY DISTRICT
8841 5. W. Commercial St.
Tigard, Oregon