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bbb05!k <br />S':• ii <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—Z <br />Building Type: ^SFD <br />32^ P;<oa.rgi\^\a\K. A\IC. <br />f he.K e Conz-h-----------------------------------Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date __\Lr i ^ ^ s <br />PwmJnkn granted to attach prkata <br />\H-O(o?12 -Ol <br />”HeTfebeTe" <br />q-aa-19.Date of Issue <br />.Pipe Material. <br />□ System Development Charge <br />. . Inspected By <br />• i <br />Pipe Diameter.^srV>.L(0 <br />UcloaS S e <br />h conformnancm to Oty tiandardt and ycfttartfan*ccwwcftoo to pubffc <br />Public Wastewater Information <br />Index Page No.. <br />Inspected By <br />**■ \ OHM <br />Downs trttamSegment No—Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />M <br />1 <br />I <br />\/!I I <br />1 ths <br />6&Qxk