bb^bo/ <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connecti 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800SCANNFn <br />Property Information <br />Address ____1:—:— <br />Map and Tax Lot — <br />Building Type: @ SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit Nn 1 <1 - 0 b M w D \________Date of Issue / \ ^f ^ • <br />rr>ntrn^fr.r/Plnmhpr Cr^-X Cf pipe Material—Pipe Diameter_iL_ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PomMon aranM to attach prtvota aaow conhactfoa to pMfc <br />□ System Development Charge •, • <br />Inspected By LU/Zv/l^ <br />h confonrmanca to Ctty <br />Public Wastewater Information <br />Index Page No. <br />Inspected By ------------;------------ <br />Segment No. ---------Contract No.UM- <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />N 3' <br />! <br />5'3"i <br />>fb <br />^ - <br />11 <br />*2-4 i <br />Q.Z°l\oZ 0 \o <br />K0RC>£LIIa?