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■i <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater ConnectgCANNED 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot__^ <br />Building Type: <br />Romt/ (Z-'ti Broce, LO /p <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information , , . .n-o\(io(o-c>\i'Permit No.Date of Issue <br />Pipe Mntftrinl 3ch-^i0 HContraetor/PInmhRr Pipe Diameter. <br />□ Right of Way Cut Permit Required <br />Installation Date -------- <br />rarmhtian gnwited to attach prtvat* <br />□ System Development Charge <br />h conformnanc* to Oty rtandortt* and tp^Mcothn*. <br />Inspected By <br />ccmucflbn to pobOc <br />Public Wastewater <br />Index Page No----- <br />^Information _ Inspected By _ <br />Segment No. I Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />3^ <br />\/t1 <br />37'