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i: <br />Public Works <br />MaintenanceWastewater ConnectiorS ANNE <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: J^hSFD <br />Owner W~\ <br />□ Duplex □ Multi-Family □ Commercial Q Industrial <br />£)Q\ Loravt*0 <br />Permit Information <br />Permit No.i^-ons^oi_____________________________Date of Issue ff <br />Contractor/Plumber Ft ham Pipe Materinl Pip^ DiameterJL. <br />□ Right of Way Cut Permit Required <br />Installation Date ~7~ /6~ 1 ^________ <br />Pmmlmhi ggwW to oifocfi prkatm T eenn^Mom to put*c <br />□ System Development Charge <br />L(xCa.$£S.Inspected By <br />*i con/ofmnanc* to Qty ttandank and tp^cUkation*. <br />Public Wastewater Information <br />\2Gr <br />Inspected By <br />P53- in $?> <br />Upstream DownstreamIndex Page No.r Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />^17^ <br />2(o'-----)N <br />0+1 *'5 s' dee^> <br />13' <br />I <br />/ <br />Uorane Hwy <br />, i.