11580 SW HALL BLVD OVAL
Oo
c
Vi
E
11580 SW HALL L)ULEVARD
Address1/.� isG S�l , �c 4�t- / Permit Nc._ r
U
Name of Occupant22/-44Permit charge
–----- _ Paid by--- /�-—
---- - Date connected_ 6 �-
Type of Building_i/ y� r� Inspection fee
ti
Service Rate ' ' Paid by -_ Date
Contractor. _ Assessment
- �/�.__Paid
Size of connection
.f �.oC�
Address-! �s �—S�c }4 ,�(� Permit No. — ;,•'�`,
Name of Oc^upant Permit charge
----- - ---- --- - -.-----_ - __ Connection fee
------_ — ---- Paid
Date connected
--- -- ---------
Type of Building Inspection fee
Ser rich Rate , Paid by Date
Contractor_ Assessment_____
Size of connection
I
APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sower service connection by the
Tigard Sanitary District, to abide by and comply with the ordinances, regi-dations 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 charges become delinquent.
1 f,.11y understand .hat all unpaid sewer service charges become a lien upon the j
property served as stipulated in O. R. S. 224.220.
I
Connections to the District's system must be In by nue contractors and/nr
bonded and .licensed plumbers.
I
Owner
,APPROVED BY
uperintendent
TIGARD SANITARY DISTRICT.'
8841 S. W. Commercial St.
Tigard, Oregon