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’Wbm^ <br />Public Works <br />I Maintenance <br />11820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Location of <br />Wastewater Connection ml <br />Property Information <br />Address _:_li—:------- <br />Map and Tax Lot-------- <br />Building Type: ® SFD <br />2‘7lo OfiXc &aANiLi£ RA <br />,____________ __,__.Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. " 0_\ <br />Contractor/Plumber Pipe Material_Ai—^ <br />□ Right of Way. Cut Permit Required <br />Installation Date \ 2-/?.?' ) l.^-------- <br />PormMan yonfrrf to aiiocfi pcMt <br />QM7^/l^Date of Issue <br />VPipe Diameter. <br />ha(-ge□ System Development <br />Inspected By l-l <br />to Oty standard* andIn <br />Public Wastewater Information <br />Index Page No. U %------ Segment No.i-^^^- <br />Inspected By <br />Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UT1UTY ONE-CALL SERVICE AT 1-800-332-2344 <br />I <br />(4£7^"Co -A L-S" <br />— Co <br />ov\dU/ pef»v\'-\ <br />|5-0^7\-oV <br />/ <br />I <br />N=> <br />0 0 <br />in'*