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bbbQLf>k <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugen6, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot — <br />Building Type: <br />7^1 Aerie Park PL- <br />M »-cVva.e. \ R <Owner <br />^^SFD □ Duplex □ Multi—Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber ^5VT'« 5 <br />□ Right of Way Cut Permit Required <br />Installation Date _____jQ-^O <br />Ptunkthn granted to attach prtvot* <br />W'O^HS'Q]S~'Date of Issue r <br />DiameterJl/.Pipe Materinl^K- <br />□ System Development Charge <br />La. 6q^SC-. Inspected By <br />ccnnoctfoa to pubOc <br />Public Wastewater Information <br />Index Page No. IfiW <br />Inspected By _ <br />Ufistreom DownatreomSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DK>, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />O ^ n^3 <br />u% dc-ep <br />oz>636CL <br />35 <br />% <br />5-<5' <br />I <br />. t.