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n»..s,Sr * <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: ^"SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />^2!) O BoardLOflAK Av/p <br />Me I teVoe. KeOwner <br />Permit Information <br />Permit No. ___ <br />Contractor/Plumber_H C t ~tC <br />□ Right of Way Cut Permit Required <br />Installation Date ___| 0 ~ — <br />schHO 4"Date of Issue <br />Pipe Material. <br />□ System Development Charge <br />Inspected By <br />amMctfoa to ptMk ***«- to conformnanco to Oty ttarxfardo and wpocHtcotkoa. <br />Pipe Diameter. <br />LaCasSe <br />romhakn pantod to attach prtmto <br />Public Wastewater Information <br />Index Page No—\0. '.^'nsPteffiUpstream DownstreamSegment No.Contract No. <br />YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344TWO WORKING DAYS/N <br />V?£I <br />7«W <br />Vf <br />/ <br />/