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!: bbSH ■•v <br />t- <br />ANNED©Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information ^ . <br />Address Wa <br />Map and Tax Lot__ <br />-Bu-fierOwner <br />Building Type: ^TSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. I O*? $~C) ( <br />Contractor/Plumber—ElCfli^__^Y.C <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Pirmimhn amnM to attach prhatt <br />i-to-n uDate of Issue <br />Pipe Materiel Pipe Diameter. <br />□ System Development Charge <br />L-a-CaSSC3-|U-|q . Inspected By <br />h contormnanc* to CKy rtandardt and tpacMcabana.connactha to pubOc <br />Public Wastewater Information Inspected By _ <br />Index Page No.—-J—J-— Segment No^^^03--------- <br />Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2J44 <br />T #33403-C lemson ^^3340? <br />hi <br />105 ->x bn£ <br />/v' <br />iVs tf iS & <br /><9\'h <br />I <br />A