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9225 SW BURNHAM STREET r .. , r� Y y_ J l R n r I. , Address J? --aaZ2- yC Permit Name of Occupant___.._____ Permit chargp_.__ C tqA n�4 Paid by Date connected Type of Building Inspection fee----- Service Rate Paid by Date Contracto '7 k Assessment '_j Paid Size of connection 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 becomr- a lies. umn the property served as 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. Owner ^_--_- APPROVED BY Superintendent TIGARD SANITARY DIS:RICT 8841 S. W. Commercial St. 'igard, Oregon