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■e CAW _________5 . <br />i o 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-----1 <br />Building Type: ^TSFO <br />le+z. Si.c • <br />O I <br />Dane. i>vif(e,rmz____________:—■— Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. IVOTSlH "O 1___ <br />Contractor/Plumber BoLliH — <br />□ Right of Way Cut Permit Required <br />Installation Date <br />/WTnfcWcvi pronto/ to attach prhatt <br />Date of Issue i' <br />U <br />Pipe Diameter_LPipe Material <br />□ System Development Charge <br />La-CasseG-56-IS Inspected By <br />comactioa to pubOc t h cantormnanc* to Oty ttandard* and tpacHkaHont. <br />Public Wastewater Information <br />Index Page No. <br />Inspected By <br />DownstreamMl2Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />t <br />o12 <br />3& <br />L <br /><