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If <br />*■. <br />h <br />: <br />Location of JMfe <br />Wastewater Connection •. <br />Public Works <br />Maintenance <br />1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address _____:______ <br />Map and Tax Lot------ <br />Building Type: ^SFD <br />^^3^ LV\ <br />May den LLC----------------------------:---------Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. I *1 ~QHS H ^ ~0 \ <br />Cnntrnetnr/Plumhfir G gy;f] M <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Pwml—lan granted to attach ptivato <br />Date of Issue ~7 ~I I ^ <br />Pipe Motorinl Sch-WO Pipe <br />it <br />Diameter^3_ <br />□ System Development Charge <br />Inspected By ____jLp. C-QAS €. <br />h conformnanco to Oty ttandardt and tpocMcadon*. <br />q-lo-JT <br />connoctfoa to public <br />Public Wastewater Information <br />Index Page No. <br />Inspected By . <br />'ZZGOl . . ..------1 —DownSfreini' Contract No.Segment No.Upstreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />ft-3 3mo <br />i <br />i <br />/ <br />i <br />. ?