IK <br />V <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ' ■ • <br />Map and Tax Lot _Z <br />Building Type: ^ SFD <br />mo R CL- <br />Owner \A/ieche.r-t <br />□ Duplex □ Multi—Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Cnntrnntor/Pli]mhfir>5'taplc ton S XC • <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Pwmltalon grant*/ to attach prtvatt <br />q- q3HS i -Q1 s-zs-nDate of Issue <br />Pipe Material- <br />□ System Development Charge <br />Inspected By __'L-<*~Ca.!s>C <br />tt <br />HSchPipe Diameter. <br />~7- (1 - I R <br />ceonacHoti to p<Mk •aotr h conformnanca to City ttandarOt and tpodlfcatknt. <br />Public Wastewater Jnformation <br />Index Page No— <br />specked _ <br />Segment No.Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />/> <br />3^ ^93711\ <br />M .3 <br /><9tf is C,'Jeep <br />i3CT <br />3H' <br />\