12285 SW HALL BLVD N
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12285 SW HAL', BOULEVARD
REMIT TC, CONNECT
Tigard Sanitary District
PEN.i,4IT N0 71 DATE - ---
PERMIT IS GIVEN TO
OF
TO CONNECT A ---
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT : ; 1.x.1. �l
THIS PERMIT MUST RE POSTE ON THE DESCRIBEP PREMISES UN'fIL CON-
NECTION IS MADE AND INSPECTI'L%N OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FE- PAID $...................................TIGARD SANITARY DISTRICT
87
CONNECTIJN INSPECTED AND "PRCVFD
Date Supe dent
l
-- `1
Address Permit No.
Name of Occupant - Permit charge
Connection fee ,10a��
Paid by_ �=�7►'LIUJ tom►-C._
Date connected
Type of Building Al I'll ! .I Inspection fee_1(� , ! —
Service Rate _ P&id by du,�hU ww- Jate /6 LZ_�
Contractor Y 2> >u Assessment Paid
Size of connection
APPLICATION FOR SEWER SERVICE
The undersigned agreeF-, is consideration of the sewer service connection by the
Tigard Sar27,ry District, to abide by and comply with the ordinances, regulations and rules of the Dist-
rict prerantly in effect or hereinafter enac�Qd and to pay sewer se-vice charges as the same may .e im-
posed from tine I- time when dus and before such charges become delinquent.
fr'ly understand that all unpaid rawer service c4arges become a lien upon the
property serves' a4 stipulated in O. R. S. 224.220.
Connr,ctions to the Distrust's system must be made by bonded contractors and,/or
bonded and licensed plumbers.
caner /J
APPROVE Y
Superintendent �
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon
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