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bM5j)f -. <br />t.-Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address . —1:—:------ <br />Map and Tax Lot------ <br />Building Type: H SFD <br />„____________ __r__: Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. - ^ 012^01 <br />Contractor/Plumber ^T^L^TObV.— <br />□ Right of Way. Cut Permit Required <br />Installation Date V?- (-------- <br />PamMon pmM to attach prM* —w conntMon to public —wtr h conformnadc* to CXy standarxt* and <br />Pipe Mntfirinl Li0l^,bbU Pipe Diameter 4~ <br />□ System Development Charge , <br />Inspected By ^^--------- <br />Date of Issue <br />Public Wastewater Information <br />Index Page - No..-Hi <br />Inspected By <br />Segment No.23^H -Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />) <br />2'-C, <br />V-&u i <br />\ <br />i <br />I <br />- T-reH-r <br />iw -I <br /><6 <br />\2?1I <br /><-----------------^O920M2OLo'236H3IN7'Re'vai um