I bbS^'l' <br />s' <br />Public Works <br />MaintenanceSCANNED©Location of <br />Wastewater Connectio 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 />c-f. <br />firmer ix)i'&clnpr-h-----.----------------------------------------Owner <br />SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Cnntrnrtor/Pliimhftr^t^pl^io^ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />frmW.Ki granM to attach prhata <br />IV050^)-Qi Date of Issue 7~ H <br />Pipe Matftrinl Sc in L( O pipe Diameter_i <br />□ System Development Charge <br />Inspected By <br />*i conformaanca to Ctty standard* and tpadheathns. <br />n <br />o <br />connocthn to pubOc <br />Public Wastewater Information <br />Index Page No. <br />Inspected By — Segment No. ^Jl3 —.^777- <br />Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />Vs <br />Vg <br />Vg ,/fe' <br />v? <br />i <br />s d> it is 5-'deeP <br />I- <br />I&' <br />\ <br />/ <br />5\ <br />. t.