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I%■ <br />i. <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection fiCANN 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____Rnrbe.r Dr <br />Owner 11 jc.'i-f* v\Map and Tax Lot <br />Building Type: SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. \ OI <br />Cnntrnntnr/Plnmhfir t^UyM~QS <br />□ Right of Way Cut Permit Required <br />Date of Issue -fT-.P-?-/ <br />Pipe Mntnrinl .Olh. HO Pipe Diameter <br />□ System Development Charge <br />-a.Installation Date Inspected By <br />h txmfomvKjnc* to CKy tiandard* and tptcMcaikina.rwmM* anwiM to erf foe* prfwf*connocth* to poMc <br />Public Wastewater Information <br />1M~1 <br />Inspected By <br />[pm <br />Upstreom PownatreomIndex Page No-Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-23+4 <br />T <br />U <br />All C0V)t^ <br />M° <br />// <br />it <br />br. <br />. {