11487 SW 95TH AVENUE wo Uffirill AA► NmItil
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-- 114.87 SW 95TH AVENUE --
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Address_ —_ ' t�1L Permit No.
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Name of Occupant_ Permit.charge �d( (T2i �.{0
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Paid by A— LV
------.---___- - _ Date cosated
Type of Building 4 Insp Oon fee 0), �Y6 4
Service Rate_.,_ (�
Paid bq r� bate_
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Contractor ` +;C °lGI '� v Assessment _ Paid
Size of connection_4_ .r
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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-
zic;tresenti
P y 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 becor-, a lien upon the
property served as stipulated in O. R. S. 22.4.220.
Connections to the District's system must be made by bonded contractors and/or
bonded and licensed plumbers.
APPROVED Rt' Owner
superin endent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon
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