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■ Hr bb'o'l/l'.5 <br />s'. <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 />Building Type: CjSFD <br />1%1 QiIa'i 1 W <br />V.aViirv<x. UuCCferOwner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. R O \ <br />Contractor/Plumber BcftOiA—— <br />□ Right of Way Cut Permit Required <br />Installation Date -------, <br />Pwmlnton aranM to attach prtvata <br />HO <br />Date of Issue <br />Pipe Material. <br />// <br />Pipe Diameter. <br />□ System Development Charge <br />L-o-tC*(Z5£€L!'5l-%o Inspected By <br />h conbmnanot to CHy ttandard* and apacHkatkma.connactfoa to ptMfc <br />Public Wastewater Information <br />Index Page No.. <br />B <br />51 Segment No.Contract No.Upstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTHJTY ONE-CALL SERVICE AT 1-800-332-2344 <br />NJ i <br />/ <br />33 9 <br />n‘ ,-a \ <br />i 5. t> dffp <br />Vg