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bbZ'b3 SCANNEHJ. <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugen6, Oregon 97402 <br />(541) 682-4800 <br />•f <br />Property Information <br />Address ___j__:__J <br />Doirre Ir h/edtCMap and Tax Lot__I <br />Building Type: ^"‘SFD <br />------------------------------— Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. |^-Qon ^0 f__________Date of Issue ,, <br />Contractor/Plumber. 2. (£, __Pipe Mnterinl ^D'^/schMD Pipp DinmetftrV <br />□ System Development Charge <br />Inspected By L-a.d,a __________ <br />Pwmhthn gnwtttd to attach prtmt* urntr ccmfctkm to putUa mwtr h conformnanc* to CHy itandardm and ip*cilkaOont. <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Public Wastewater, Information <br />Index Page No. <br />Inspected By - <br />Upstf^om Downstream- <br />3^Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />13' <br />Otfr <br />/ <br />Vs V <br />s' <br />I <br />. {