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i: <br />Public Works <br />Maintenance______ <br />1820 Roosevelt Blvd. <br />Eugend; Oregon 97402 <br />(541) 682-4800 <br />Location of <br />Wastewater Connection m- <br />Property Information <br />Address ■ '732 Po^ rn nre, S^ <br />72mMap and Tax Lot <br />Building Type: j^fSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. <br />Contractor/Plumber_Ky\t>uJ*"T <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Ptrmhthn granttd to attach prfvott <br />n-iq-i1?Date of Issue <br />Pipe Material Gcly HQ <br />n <br />Diameter^li_Pipe <br />□ System Development Charge <br />Ji'rvA 1—Inspected By <br />tofubHc <br />Public Wastewater Information <br />Index Page No.^—~7 7— Segment No.pecin*iznsmu Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344T <br />O''I <br />) 6^r <br />Yb lL2-1v«/ <br />^5 Q) <br />i O <br />A £n ir\ <br />\O <br />CoVMiecVeJ \ <br />"Vo H "s+ob <br />Uo