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bbH4~\■i <br />i <br />4 <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection CAN ME 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address •____ <br />Map and Tax Lot___ <br />Building Type: ^SFD <br />IHQS S'\' <br />-------------------------:_____Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No.__ <br />Contmctor/Plumber ___________ <br />□ Right of Way Cut Permit Required <br />Installation Date _£> " I I 9_____ <br />Date of Issue ~1 ~h' 1 ^ „ <br />Pipe Mnterinl &__Pipe Diameter^ <br />□ System Development Charge <br />Inspected By <br />h conformnanc* to CHy wiandordt and yeWbotfcri*PwmhtkM grc*\M to attach prtmto connactfoa to pubOc <br />Public Wastewater Information <br />Index Page No.—LLLA Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />Q $ 13345f <br />N 4s <br />|0^' <br />c\opoVAiC_ <br />\7 33\0 & <br /><o"\c ec+ +0C <br />CD <br />/ <br />. s