11525 SW 95TH AVENUE -- 11525 SW 95TH AVENUE
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Address L1: � _ Permit No. 2�
Name of Occupant_ Permit charge 2, 0 4__
fee_ �
Paid by (' /
Date connected
Type of Building Inspection fee ZA Q_j:P _
Service Rate U _ Paid by "r� _Date X__
Contractor. /
AaessaneW_._�,{��Paid
Size of connection _
APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer service connection by the
Tigard Sanitary District, to abide by and comply wit'i 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 sich charges become delinquent.
I fully understand that all unpaid sewer ttervice charges become a lien upon the
property served as stipulated in O. P. S. 224.220.
Connections !o the District's system must be made by bonded ntractors and/or
bonded and licensed.plumbers.
Owner
APPROVED BY
Superintendcait
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon