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5 <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connectio 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800SCANNE <br />r^>£L1D L <br />w <br />Property Informati <br />Address ______ <br />Map and Tax Lot — .—____ <br />Building Type: ^fsFD □ Duplex <br />Jl ■ <br />Mi/Uifi I \(IrrOwnertl <br />□ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contmctor/Plumber■R>.!faW>ll <br />Date of Issue <br />Pipe Material^10 <br />'( <br />Pipe DiameterM <br />□ Right of Way Cut Permit Required <br />Installation Date ___________:______ <br />□ System Development Charge <br />/■ a(”/7£ge <br />to CXy Handardi and tpicHlartfana. <br />Inspected By <br />Pwm/mlan granted to aitacfi prfvot*eowetfow to piMh <br />Public Wastewater Information <br />Index Page No.— <br />'nspecte^ <br />Upstreom DownatreomSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU WG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />/K <br />r<?nnec-f <br />+o etis^ <br />-o.c/X. <br />s •V I Isz