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i's, <br />5 <br />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__ <br />Building Type: □ SFD □ Duplex <br />375~ tTowa- 5~h <br />spongers Xv\^. <br />^^'Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. \Cf' ~Q i <br />Contractor/Plumber Z-ig <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PmtMon arantod to attach prhatm <br />Date of Issue 3 19 <br />Pipe Materinl 303 ‘-j <br />fr <br />Pipe Diameter^.£xc. <br />□ System Development Charge <br />L<xC o. ^v-zi-n Inspected By <br />h contormnanc* to aty ttondorOt and tpadfkathna.connactioa to putOc <br />Public Wastewater Information <br />Index Page No. <br />Inspected By <br />qo3^Segment No.Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UT1UTY ONE-CALL SERVICE AT 1-800-332-2344 <br />pobUc c-lo/i <br />C?<3S/N 90- <br />6 XL. <br />ua <br />\j/ <br />-t.c <br />. I