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scanne Public Works <br />Maintenance <br />‘HlSZO Roosevelt Blvd. <br />Jr Eugenis,• Oregon 97402 <br />(541) 682-4800 <br />mLocation of <br />Wastewater Connection <br />Property Information rj ^ ^ £TE&UNA WOOtlS 'D'i <br />. AQorsss----------- , _ . • , <br />Map and Tax Lot <br />Building Type: m SFD □ Duplex’ ' □'Multi-Family □ Commercial □ Industrial • <br />Owner <br />! <br />Permit Information <br />Permit No. \^>028n(o-Q.L- <br />Contractor/PlumbeL—£,v‘-1 ' <br />□ Right of Way Cut Permit-Required <br />Installation Date b® l Q.l,./ ' ^—------------------- <br />, prmM to attach print* •rrtr eenh^thn fa pobOa —ry <br />Public Wastewater-Information.. <br />Index Page No <br />_Date of Issue 0*1/ H / <br />— Pipe MaterialPipe DiameterJi! <br />nW□ System Development Charge ' <br />Inspected By ^ <br />h txntomrraric* fo CXv itandonf* and kmcMcoVom. <br />Sq Contract No.