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i <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />^77 (Alii Um AiJpProperty Information <br />Address ___--------- <br />Map and Tax Lot — <br />Building Type: j^pSFD □ Duplex □ Multi—Family □ Commercial □ Industrial <br />Krciirvi a |Owner <br />Permit Information <br />Permit No. <br />Contractor/Plumber <br />□ Right of Way Cut Permit Required <br />Installation Date ___(I ~ -------- <br />H-az-ao19-0 ^£.^-01 Date of Issue <br />Pipe Material v*Pipe Diameter. <br />□ System Development Charge <br />Inspected By ___l—Q>- C^a-SSc. <br />h conformnaoc* to Oty standard* and iptctftertJon*.cannsctkm to publicPsrmhdoo grxnt*! to attach prhoto <br />Public Wastewater Information <br />Index Page No. <br />Inspected By <br />75"Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />f0 <325 <br />n <br />(n <br />iSar 1 <br />^77 U3i II01O <br />I \n