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'k Ph <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 />I'feaiher farovt Ln. <br />Owner _____________— . _ _ . - <br />Building Type: ^SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />I5ruce her't' <br />Permit Information <br />Permit No. _______________________, <br />Contractor/Plumber 'f)rl <br />□ Right of Way Cut Permit Required <br />Installation Date —__ <br />PwmMan granted (a attach prtvota <br />30-00436-01 3-13-30 I /Date of Issue <br />Pipe Material- <br />□ System Development Charge <br />Av confufTtvhjnc^ to Cftv standard* and soscdlfcattoiM* <br />Pipe Diameter!!Sch.HO <br />/3~ AO Inspected By <br />connacttoa to pUrtc <br />Public Wastewater Information <br />Index Page No. <br />Inspected By - <br />Upslreom PownstreomHTSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />M <br />/N <br />i <br />Hi^> <br />i !\KiH i10Ys3i <br />i