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bb5 )°\ ,•# <br />fl <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenis, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address -------:------- <br />Map and Tax Lot__ <br />Building Type: <br />A\/e.ra <br />owner PaiAie.1 Pori~er <br />SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber_L: <br />□ Right of Way Cut Permit Required <br />Installation Date ___^— <br />ao-oiaoq-oi 3 ~c)S'3o <br />cch. <br />Date of Issue <br />Pipe Material- <br />// <br />Pipe Diameter.fAKl <br />□ System Development Charge <br />Inspected By <br />connmMon to pubUc —w h conformnanoi to Oty ttandard* and tp^cMarthn^PtmMcn gnjnM to attach prtvrt* <br />Public Wastewater Information <br />Index Page No. <br />, Inspected By^ --------fcLZSn Contract No.S'5'Segment No.Upstrcom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />S<3y\W Clar^- At/6-d 36 / <br />0 <br />/