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lobb l^jO' <br />i <br />4 <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: <br />Ave.. <br />HomejS bTnc..Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No.\q-o3-iH3-oi <br />Contractor/Plumber ^and [A <br />□ Right of Way Cut Permit Required <br />Installation Date -------------!-----:------------- <br />Date of Issue / ~ / 9 <br />Pipe Material Diameter^Pipe <br />□ System Development Charge <br />Inspected By ___I___^ v... <br />PtrmMon grant+d to attoc/i prAato omnr connoctha to pubOc oowtr h conhrmnonco to CHy Handanto and wpotMcotkno. <br />La sSC- <br />Publlc Wastewater Information <br />Index Page No—un­ <br />inspected By _<3300/ 33*6DSegment No.Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALI UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />n <br />\%$ <br />nJ' <br />7 <br />i <br />^ tf iSlr <br />i <br />"V