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MMcn <br />: <br />. <br />-i.'^ Public Works <br />^Maintenance <br />«■ - <br />Location of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 ___ <br />•f <br />Property Information <br />Address . ' ; —:----- <br />Map and Tax Lot------ <br />Building Type: fi SFD <br />£T <br />c_____________:__r__Owner _________:__:___:------------ <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. __(tf /zu /\°i <br />Vi VirQ pipe Diameter, <br />large <br />H-0b~7\{<-O\ <br />nr'ptrnr-t-r.r/PInmhpr LA ------pipe Material <br />□ System Develoj ( <br />__ . Inspected By L-Vt>v<|.K. <br />Date of Issue <br />□ Right of Way. Cut Permit Required <br />Installation Date <br />Permlnian granM to attach prtvat* <br />r\\*A <br />h canformnaoc* to CHy •tarxtard* andconnection to pobtk <br />Public Wastewater Information <br />Index Page <br />7gWnspect|dooiSegment No..Contract No.DownstreomUpstreom <br />TWO WORKING DAYS BEFORE YOU DKJ, CALL U11UTY ONE-CALL SERVICE AT 1-800-332-2344 <br />S'-T I <br />20-7^ <br />ToN <br />A <br />TTe\2"! <br />T--0-/—o <br />C0*t <br />nstb <br />\A^67 ST ! <br />C'i