11380 SW LOMITA AVENUE 11380 S''1 LOMITA AVENUE
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N? 693 DATE �`,_ �! 6 r
PERMIT IS GIVEN TO S ►
OF 0V 6
To CONNECT ATO THE SYSTEM OF TIGARD SANITARY DISTRICT
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THIS PERMIT MUST BE POSTED ON THE DESCRIBED PRRMISF.S UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION 11AS REFN COM-
PLETED.
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PERMIT FEE PAID $..."'r..~.....................TIGARD SANITARY DISTRICT
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CONNECTION INSPECTED AND APPROVED `
- ----- --Date Su yin ndmit
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Address �� 3J4� <LQ Permit No. �
Name of Occupant_
Permit charge
— ------ -- ---.- Connection fee .S 4 _
---- ---- __. Paid by-;�,��• !i�b �-� 4
Date connected
/"n.-- �U
Type of Buildin --- _ A
9___/' k Inspection fee_.__
_
Service Rate C s, •_ G z-
_-_ Paid by r Dated+ _
COntIaCtOIC!G���Y1��"'�
- - --. _ Assessment- Paid _
Size of connection
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APPLICATION FOR SEWER SERVICE `4
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-
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.
I fully understand that all unpaid sewer service charges become a lien upon the
property served as stipulated in O. R. S. 224.220.
actions to the District's system must be made by bonded contractors and/or
bonded and licensed riambers. /
Owner i
APPROVED BY j
Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon 1)
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Construct4.on Pd-3/ 13/62 $350.00
Ener -148. 50
Supt. .. r-0.00
- i Refund $101.50
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T-o 'Z.-I-ela
Address Permit No.
Name of Occupant Permit charge
Connection fee
Paid
Date connected
Type of Building_____ Inspection fee----
Service Rate Paid by ---Date--
C-ntractor Assessment Paid
Size of connection