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■ g:b>b6$0sr <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />W 13^ AProperty Information <br />Address --------:-------- <br />Map and Tax Lot__ <br />Building Type: <br />Chrlziopher. CoiACar <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />eJ SFD <br />Permit Information <br />Permit No. 'AC> QOlG G'O I <br />Contractor/Plumber <br />□ Right of Way Cut Permit Required <br />Installation Date --------- <br />Pwmlnkn granttd to attach prMft* <br />3^3 -30 V"Date of Issue <br />Leland XftLCe Li__Pipe Material <br />□ System Development Charge <br />-a Ca <br />Pipe Diameter. <br />Inspected By <br />h conformoanc* to Cfty rtandarda and wpacMcadona.connacttoa to euhffc <br />ationPublic Wastewater Inf <br />Index Page No.. <br />Inspected By_ <br />Downstream Contract No.T 5oq.\0b Segment No.Upstream <br />TWO WORKING DAYS BEFORE YOU WG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />4^17^- <br />-------------------------- <br />C? iS 3 dee+> <br />133'> <br />/ <br />1*1w. 13^