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bb53']) <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />'57.5? Sj/efzProperty Information <br />Address --------:-------------^ <br />Map and Tax Lot------ZI <br />Building Type: <br />Rut/e.r Honie d JZnc <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. _ <br />Contractor/Plumber <br />□ Right of Way Cut Permit Required <br />Installation Date ------' /<P ‘clQ. <br />Pwmimk* granted to attach pchota <br />30 - OOQ9I-OI 1-10-30 <br />SCh- HO <br />Date of Issue <br />Pipe MateriaL <br />// <br />VPipe Diameter. <br />□ System Development Charge <br />L<LCaSSCLInspected By <br />to <br />Public Wastewater Information <br />Index Page No. <br />Inspected By — <br />Upstream DownstreamHISegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTHJTY ONE-CALL SERVICE AT 1-800-332-2344 <br />/1\ <br />/in <br />if <br />T,' y/fcb n‘i <br />i- <br />«-fs 6 <br />'4 ^I <br />1 <br />4?l5to <br />i ■