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bbb\0fl .* <br />■- <br />i <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: <br />Tor be. I <br />rTorrift-YA JC\iexs&{AOwner <br />(EjHzFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. ______^ <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Reguired <br />Installation Date ___I 1 <br />Prnmktkm gnwiM to attach prtvot* <br />IT 03^63'Of Date of Issue <br />Pipe Material- <br />n <br />S^h-HO Pipe Diameter. <br />□ System Development Chargeu^cAseInspected By <br />h conformnanca to Oty Handarda and modRoatjan*connection to pobOc <br />Public Wastewater Information <br />Index Page No.HH Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-BOO-332-2344 t <br />N <br />£ <br />do / <br />vp <br />c J <br />/Io <br />I