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i- <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugen6, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:_:___ <br />Map and Tax Lot—Z <br />Building Type: <br />bro\/e. Ln. <br />-----------------------------------Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. O ~ O 1 ^ 3 ^ "~C) f <br />Oontrnotor/Plumhftr <br />□ Right of Way Cut Permit ^Required <br />Installation Date ____H ^ 3 ~ ^ <br />Pvmlntai grvntad to aitoch ptivott <br />Date of Issue ^ ^ /< <br />Pipe Material h_^O Pipe Diameter—!__ <br />□ System Development Charge <br />Z-r* £/J$S<Z <br />h con/brmnanc* to Oty tiandardm and wpccMootiona. <br />Inspected By <br />conn»dk*i to potOc <br />Public Wastewater nformatlon <br />Index Page No..—^dZl 3£12^p^^MaUpstream bownstrearnSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU [MG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />T <br />N <br />a<?&S3'V/(,/N M <br />ffis 5'Jeep <br />iV 7 <br />\y