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(3 bSib^if*.- <br />3 (•# • <br />fii <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information n \ c~ 11 I ) <br />Address ^ <br />Map and Tax Lot <br />Building Type: ^SFD <br />(bco\Je Ln. <br />Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit InformationPermit No. \ A ' O^ (? i'C) I <br />Contractor/Plumber ^y~\ <br />jj^nd3Date of Issue <br />Pipe MateriaL <br />□ System Development Charge <br />Inspected By ___L-A C-clsSC. <br />h oanfonrinaoct to Ctty •tandarxlw and tp^cMcaHona. <br />'/ <br />VPipe Diameter. <br />□ Right of Way Cut Permit Required <br />Installation Date —^ ~ l9 ’ SiO. <br />Pwmlnbn granM to aitoch prtoato corwctfbw to poMc <br />Public Wastewater Information Inspected By^ <br />Segment No.Index Page No.-Contract No. <br />DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344OTWO <br />f <br />33 <3?a'/V - 4 <br />7"0I <br />70 <br />nF ! <br />I <br />l