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f. <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connectio "SCftNNE 1820 Roosevelt Blvd. <br />Eugeng, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot — <br />Building Type: <br />AJehextei/yT L>r. <br />Bruce. Vjiecher t <br />^'SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. _______n-05033-01 Date of Issue ~7'nlH~(C\ <br />Pipe Mnterinl Pipe Diameter <br />□ System Development Charge <br />*i confcmwono to CHy •tandarxir and •ptcfilcationt. <br />Contraetor/Plumher ^ taplfitgig &XC- <br />□ Right of Way Cut Permit Required <br />Installation Date ___S-IS~I ^________ <br />Pwmtthn graiM to ottodi ptftoto mow coonoctkm to pubUc <br />Inspected By <br />Public Wastewater Information <br />Index Page No—H 7 <br />Inspected By ______________ <br />Downstream Contract No.Segment No.Upstreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />alevn Dr. <br />sS' <br />ff is deep <br />Vs / <br />15 <br />£s>/ <br />/ <br />7