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? - <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugen6, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____ <br />Map and Tax Lot <br />Building Type: <br />"SCn 'X 'TnS <br />^fSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information ^ . <br />Permit Ne. ^-0510^-01 <br />Date of Issue <br />Pipe Material. <br />// <br />Oontrnator/Plumber OdtOrl M LcO-W>DiametecrLSck HO Pipe <br />□ System Development Charge <br />Inspected By <br />h ccnformnanc* to Oty Handardo and wpodlhathno <br />□ Right of Way Cut Permit Required <br />Installation Date ___j. j. <br />/Vwjjfcjfaj grantod to attach prtnto <br />LaGx£$£ <br />connoctfoa to pubOc <br />Public Wastewater Information <br />Index Page No.-——-1 H <br />Inspected By _ <br />J3ooi algos' <br />Ups tr tom DownstreomSegment No.Contract No. <br />■mW WORKING DAYS BEFORE YOU CHG, CALL UT1UTY ONE-CALL SERVICE AT 1-800-332-2344 <br />Tyson Lf\.13' <br />34 <br />JO <br />-ffiS 4'^e£? <br />S'/'3-y? <br />-7 IS'5 <br />.