1 bb'h'15 <br />i. <br />NEILocation of O ^ T <br />Wastewater Connection <br />Public Works <br />Maintenance <br />1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot — <br />Building Type: <br />l ^58 Pe.5cht/fes A\/e. <br />-ieiima^ T Home*Owner <br />^fSFD □ Duplex □ Multi—Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber 'TjYVI. <br />□ Right of Way Cut Permit Required <br />Installation Date ____^/-3 9v ^_____ <br />Date of Issue <br />Pipe Material..SC-fo- Pipe Diameter.V" <br />□ System Development Charge <br />. Inspected By <br />rwmbt/on granted to aitocft prtooU »wrT conMcOat to putOc »—r h cantormnanc* to CKy rtoKlarck and tp^cMkaHan. <br />Public Wastewater nformation <br />Index Page No. <br />kispec^B^ <br />"Dpstreom Downstreom'Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DiG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />Peschat£5 A\/e. <br /><—IN4 7* 3%’ <br />z\l <br />ye <br />-4 i5 <br />6 s Aeey <br />I <br />lL/ <br />y?i <br />Ae r / <br />. I