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bb^c <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-48005^ <br />Property Information <br />Address ____:--------- <br />Map and Tax Lot —=: <br />Building Type: ^}"SFD <br />•ViolWn A^C.I55o oah <br />Bryce__________________Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No.__.____r-aH?\cl-03^H-Ol Date of Issue__________ <br />Pipe Mnterinl w Ch C' p(pe Diameter.Contractor/Plumber ^ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />/VroJ—ton granttd to attach pcfvota <br />□ System Development Charg <br />Inspected By ___-a — ^__ <br />caanactiom to put/k t h conformnonca to CXy ttandan* and tpadtkatiana. <br />e <br />Public Wastewater Information <br />Index Page No. <br />Inspected By--------idnalL" Contract No.Ml Segment No.Upstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CAUL SERVICE AT 1-800-332-2344 <br />t ■ v$i <br />aw <br />n <br />i <br />I <br />1 <br />. i .