9230 SW BURNHAM STREET N
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9230 SW BURNHAM STREET
Address C1 ,0 tl vz��7'( Permit No. !
Name of Occupant/V�." �E � permit charge.--_____
Connection fee
— Paid by ---- —---- — -
Date connected -,-./-----' - 2 3 " /
Type of Bui,ding _—_ Inspection fee__________
Service Rate 2.00 r Paid by Date
_ � V'
Contractor Asaessment ,�G''nn
,j�-_Paid
Size of connection —i�r
APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer service connection by the
Tigard Sanitary District, to abide by and cumply with the ordinances, regulations and rules of the Dist-
rict presently in et.`ect or hereinafter enacted and to pay sewer service charges as the same may be im-
posed from time to tima when due and before such charges become delinquent.
I fully understand that all unpaid sewer service _harges become a lien upo^ 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. i
Owner
.APPROVED BY
iSuperintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon
Yt,
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