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bb%ii '* • <br />.CANNE n ^ Public Works <br />Maintenance <br />IT <br />Location of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend,- Oregon 97402 <br />(541) 682-4800 <br />•f <br />Property Information <br />Address . '_:—L:—:----- <br />Map and Tax Lot------ <br />Building Type: □ SFD <br />2HS V.\NC\ 5%. <l\-VO <br />^______________;_____: Owner <br />□ Duplex □ Multi-Family B Commercial □ Industrial <br />Permit Information <br />Permit Nn \ ^ ~ O'2-U'lb "D\ ■________Date of Issue 1 ^ / 1c/ <br />Contractor/Plumber CpW^hAT ----Pipe Material <br />□ Right of Wdy.Cut Permit Required <br />Installation Date <br />PermMon aranM to attach prlvota <br />I »«Pipe Diameter . <br />□ System Development Charge, ' . * <br />Inspected By t^V <br />h ccnfotmnanct to CXy ttandan* and tpacttfcathnt. <br />M/oU / \C\ <br />corinacthn to pubth <br />Public Wastewater Information <br />Index Page No.s.,™, ^avusT^°n Contract No:Upatreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />O \o£U4 <br />SAor-rNA <br />> c <br />ess <br />£ <br />piM-0 l <br />O 10^46-o- <br />271 hi <br />/