11467 SW 95TH AVENUE 11467 SW 95TH AVENUE
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Ad;',ress
Permit No.
Name of Occupant____---,-- Permit charge +. ;
Paid by
Date connected
Type of Building
Inspection fee
Service Rate3G G
— Paid by Date
Contractor •
"0" Assessinent-_ Paid
Size of connection
APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer service connection by the
Tigard.Sanitary District, to abiCle 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 befora such charges become delinquent.
I fully understand that all unpaid sewer service charges become a lien upon the
property served as stipulated in O. R. S. 224.220.
Connections to the .-Astrict's system must be made by boyded L.mtractors and/or
bonded and licensed plumbers.
Owner
APPROVED FY
q�_iperinteadent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon