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bbHS3f ■.•< . <br />i'■CANNE m Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 ___ <br />Property Information <br />Address . ___1:_:___ <br />Map and Tax Lot------ <br />Building Type: g] SFD <br />\ ^ 0^1 E D ^y/ <br />________________:__T__.Owner <br />□ Duplex □ Multi-Family □ Commercial Q Industrial <br />Permit Information <br />Permit No. • l -__ <br />rr.nfrnrtr.r/Pliimhpr-'^T^ . Pipe Material. 1'- . Pipe DiameterJlL_ <br />□ Right of Way. Cut Permit Required □ System Development Charge <br />Installation Date j i------- . Inspected By LI------- <br />PemMcn oronM to attach prtnta amr ca»wc«w to pubtk ~wr h confonrinanca to Oty atandorda arki m»cMcathn*. <br />H-o65b0~a\Date of Issue <br />Public Wastewater Information <br />Index Page No. ^3-?o^nsp°%&\ySegment No.- Contract No.DownstreamUpstream <br />TWO WORKING DAYS BEFORE YOU DfG, CALL UT1UTY ONE-CALL SERVICE AT 1-800-332-2344 <br />l <br />>. <br />I <br />0 oiI2W2o^\o