10005 SW JOHNSON STREET-1 s
10005 SW JCHNSON STR UT
r�
V:
(moi
C
O
ti
3
Ln
O
O
O
..Y1f
Tax Lot 2 ST 2 AA 2.300 23-10 North Tigardville Addn
Assessment 262.705
Lateral 67 .06
329.76
11-1«61 16.99 !
& SA thereafter
Address ���_h��� 5� Permit No. _
Name of Occu ont - _ d
P Permit charge J 6
-----------_ ----------- --- Connection fee_ 2 0 0 0
--------------- - -- Paid by �` 'ti - .44-(
Date connected
Type of Building cIU"L�ScLti
_ Iner:,ction Jfee- t
Service Rate_ Paid by ,/'��' �S Date_ _
Contractor
Size of connection__.._!
IJ
i
APPLICATION FOR SEWER SERVICE
Tl,a undersigned agrees, in consideratic i of the sewer service connection by the
Tigard Sanitary Distect, to abide by and comply with the ordinances, regulations and rules of the Dist-
rict presently in effect or hereinafter enacted ai d to pay sewer service charge.-,as the same meq be im-
posed from time to tine when due and before such charges become delinquent.
I fully understand ff at all ui.paid sewer service charges be,:ome a lien ,--,I the
p-operty served as st.pulated in O. R. S. 2^4.220.
Connections to the District's system must be made by bonded contractors and/or
bonded and licensed plumbers.
Owner
APPROVED BY
Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Cowrnprcial St.
Tigard, Oregon
I
t
to