11485 SW 95TH AVENUE I
11485 ,SW 95TH AVENUE
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Address ��� Permit No.
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Name of Occupant Wti"` '� Permit charge
Paid by
Date cd�nected C)
Type g_Q'�ld ��
T e of Building �� _4 Inep9cjtion
Service Rate._ Paiby Dates. o -�TGO
Contractor ^�kl 1. i Assessment �//_Paid
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Size of connection�4e — --_
APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer s.ervi.;e 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,aharges become delinquent.
I fully understand that all unpaid sewer serv,ce charges become + lien upon the
property served as stipulated in O. R. S. 224.220.
Cowiections to the District's system must be made by bonded contractors and;or
bonded and licensed plumbers. _�---
Owner
APPROVED BY
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Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon
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