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bb5b°\s- <br />lii <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugeng, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:_:— <br />Map and Tax Lot — <br />Building Type: <br />Aiye. <br />k<° P,\jr>n ha.n~) <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. .__ <br />nnntrnrtr»r/PlMrnhftr Pipe Mntftrinl 6^S <br />I9- I 11-19-13Date of Issue <br />4"Pipe Diameter. <br />□ Right of Way Cut Permit Required □ System Development Charge <br />la 6aInspected By <br />ccontctioa to poMc mtnr h ccnformnancm to Ctty Miantfanlm and tp*c/lfcailont. <br />Installation Date <br />PwmMon granted to attach prhtata <br />Public Wastewater.Information <br />Index Page No i.C. <br />^ Inspected Byqg.vr \To?£? <br />Upstreom ‘ DownstreamSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTtUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />'1? <br />10 <br />zd i <br /><