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11425 SW 1,0MITA AVL.NUE
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ddress����� �C�/�'I� ��`� d� Permit Nu. r '~
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Name of Occupant Permit charge
dIJ d Cd CO SX, a a-r Connection fee___>>
Paid by
Date connected
Type of Building ,,' /I n'
Inspection fee
Service Rate _ Paid byt_� l �d f"(� Data'?-
Contractor In k A A Assessment-- Paid
Size of cor.nection—e� �C-�'
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-
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. B. S. 224.220.
Connections to the Di3trict's system roust be made by bonded contractors and/or
bonded and licensed plumbers.
Owner
APPROVED BY uperintendent
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8841 S. W. Commercial St.
Tigard, Oregon
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PERMIT TO CONNECT
Tigard Sanitary District: -
1Y
PERMIT N? 697 DATE '
AT I9 GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD ,4ANITARY DISTRICT��
AT
THIS PERMIT MUST BE PC STED O!f THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND IPISPECTIO'l OF CONNECTION HAS BEEN COM-
PLETED,
PERMIT VER PAID �...::'�.........................TIGARD SANITARY DISTRICT
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CONNECTION INSPECTED AND APPROVED
Date - --
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