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bb3%0>f..* - <br />ylr <br />Public Works <br />MaintenanceCANNED^Location of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot__ <br />Building Type: □ SFD J^/lJup\ex <br />IS1-]3 Happy Lr), <br />^oV\rN arxj LoriOwner <br />□ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumher 3.Y.C* <br />□ Right of Way Cut Permit Required <br />Installation Date __:__ <br />Parmlmion aranfd to attach prfvota <br />\3i05127-0)Date of Issue <br />Pipe Material Pipe Diameter <br />•t <br />□ System Development Charge <br />Inspected By <br />h conformnanca to Oty atandarda and tpacMkathna <br />Public Wastewater Information I <br />Index Page No.^—— Segment No. <br />Inspected By <br />lot, I Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />T <br />AcPQ KH ' Conned +° <br />Conned fa ^ AS5 <br />i <br />. t.