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bbl\£i'L' <br />\ <br />Public Works <br />MaintenanceCANNEC3©Location of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugen6, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ________ <br />Map and Tax Lot__! <br />|^7Q L. I5- Mt . I538 V.llavA <.+.0. .Owner <br />Building Type: □ SFD □ Duplex □ Multi-Family ^Commercial □ Industrial <br />Permit Information <br />Permit No. I ^ ~ l ~ Q l______ <br />Contrnotor/Plumhp.r SnY\C <br />)i-H9Date of Issue <br />Pipe Material 303*/Pipe Diameter ^ / V <br />□ Right of Way Cut Permit Required <br />Installation Date <br />rtmJmhn granted to aitodt prtvoU <br />□ System Development Charge <br />La.Ca.SSec-iq-iq Inspected By <br />*i ccnformnanct to CKy HandanM and tp^cUkatiana.oofwetfow to poMc <br />Public Wastewater Information <br />1133 'nspec^|5 <br />Upstreom CownstreamIndex Page No.Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />f. 15- <br />Ino <br />tj <br />,<270 e-15To11 <br />& / <br />X <br />T <br />To I <br />. i .