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bb570■* <br />f/h <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 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 □ Duplex □ Multi-Family ^Commercial <br />7^0 Ga nAlfi \\g Dr. <br />__ '______________l^Owner Leg. <br />□ Industrial <br />Permit Information <br />Permit No._ <br />Contrac <br />^-0^931-0) <br />tor/Plumber <br />□ Right of Way Cut Permit Required <br />3-5‘-d-0 <br />1-7-17Date of Issue <br />Pipe Material- <br />•I <br />Pipe DiameterJZHo <br />□ System Development Charge <br />Inspected By <br />h confamnanc* to Oty ttondarfr and wrucHfcaVon* <br />Installation Date <br />CtVVMCtfM to put>8cPwmMco grmttd to attach prtooto <br />Information <br />S3 <br />Public Wastewater <br />Index Page No----- <br />Inspe\?p3o <br />UpstrcarnSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-BOO-332-2344 <br />3 <br />it <br />tiH 17 <br />i <br />31° <br />'J/ <br />, t -