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bbH'l'^6 <br />Public Works <br />MaintenanceLocation of ^ v <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Euqend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address Q <br />Map and Tax Lot_I <br />Building Type: <br />\ tA c ^ Vv/a-%o a \ <br />of, 5<° Lh <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. <br />Contractor/Plumber ------ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Ptrmkthn granted to attocti prftoto <br />n- OX65-PI Date of Issue M^ <br />Pipe Material <br />u <br />U <br />Pipe Diameter— <br />□ System Development Charge <br />LciC-aSSfInspected By <br />connection to puMc fewer h conformnanco to Oty tiandorth end ipecMcatkinr. <br />Public Wastewater Information <br />51 <br />Inspected B231^Segment No.Index Page No.Contract No.Upstreom <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-3J2-2344 <br />4- <br />W <br />91- <br />>■ <br /><o\‘ <br />O6.1 c7?~C <br />c <br />QJzI <br />5ej <br />v