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bb&Zt <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 ------1:—— <br />Map and Tax Lot — <br />Building Type: □ SFD □ Duplex □ Multi-Family ^Xommercial <br />ftia Land 6>rOOprp <br />Owner \sV.tTi. <br />□ Industrial <br />Permit Information <br />Permit No. ’ <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date -------3 “ i *^>r <br />aranM to attach prhat* <br />3^3Y__pipe DiameterJ^!. <br />□ System Development Charge <br />Inspected By QSS C.--------- <br />Date of Issue <br />Pipe Material- <br />n <br />h to Ctty ttandard* andto <br />Public Wastewater Information <br />Index Page No. ~7^Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />t <br />N \ <br />i <br />i