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•t . <br />^ Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />mi <br />iff <br />Property Information <br />Address . __—1:—:----- <br />Map and Tax Lot------ <br />Building Type: H SFD <br />^\LbT2- St / <br />____________:____.Owner <br />□ Duplex □ Muiti-^-Family □Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber_ <br />□ Right of Way Cut Permit Required <br />Installation Date _ <br />PennMon granM to bHdcft ivAoto <br />i/ob/iq <br />W H-D Pipe Diameter-H*- <br />___Date of Issue <br />,___Pipe Material_ <br />□ System Development Charge <br />___ . Inspected By U\QVet.okl2/\9,/ H <br />h confbtmnonc* to Oty •iarnford*ccnn*eUon to puMc <br />Public Wastewater Information <br />Index Page No—1=0 <br />- ., _ Inspected By <br />Segment No. ■ ..-?3\SA.Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />I <br />i <br />L7 <br />I __ .L <br />g <br />i <br />k <br />& ! <br />'y'lb' <br />« 20 <br />^ I o221Wy2.21^0 <br /><i\ LET Z.