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i)b^5of •.•* »h <br />^ Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend,- Oregon 97402 <br />(541) 682-4800 <br />•< <br />Property Information <br />Address . '—:—------- <br />Map and Tax Lot------- <br />Building Type: USED □ Duplex □ MultH-Family □Commercial □ Industrial <br />'/ <br />Owner <br />Permit Information <br />Permit No. 1 --O (?V <br />C‘>->nfrnr:tr>r/pllimhpr Material <br />□ Right of Way. Cut Permit Required <br />Installation Date <br />PcrmMon oranM to aitocfi Pffcrt* »T conmctha to poblk <br />\r/-or/M <br />SC-VtC/o <br />Date of Issue <br />H-*Pipe Diameter. <br />Xk.;□ System Development Charge <br />L\ KWInspected By <br />kt ccn&JinvhJncw to CHy and <br />Public Wastewater Information <br />Index Page <br />Inspected By <br />Tfownstreom\lz\lNo.Contract No.Upstreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />w Q <br />2^o'I <br />L W •91/ <br />• ^oO <br />;• w Tr€.3'-12LV <br />to l <br />E i <br />N <br />C <br />L1 E !N I <br />IK <br />u <br />0 <br />H2\2