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i <br />Public Works <br />MaintenanceWastewater ConnecSOA <br />1820 Roosevelt Blvd. <br />EugenO, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address _:____:__ <br />Erucf. LQiechpr't HorwpfMap and Tax Lot___ <br />Building Type: Jzl'SFD <br />Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. OSO$Q 'O I______ <br />Contractor/Plumber • <br />□ Right of Way Cut Permit Required <br />Installation Date -----^ " 1 ( <br />granHd to attach print! <br />Date of Issue ~7 'I 9~/9 <br />Pipe Material <br />// <br />Diameter^_Sok-L/Q Pipe <br />□ System Development Charge <br />La,CaZSeInspected By <br />to atytoh <br />Public Wastewater Information <br />Index Page No. <br />Inspected <br />Segment No—^ s(f</j -Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />Vg <br />V? / <br />31 <br />V/fo <br />.7 <br />/ <br />j’deePO tL is <br />I <br />25 <br />17 <br />^ • <br />. I .