bbS^bI <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 />8^ Q Kp l Dr. <br />Ma/J6en o iruc ’hot) <br />Building Type: □ SFD □ Duplex □ Multi-Family ^Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No.Ll-S-lV <br />Contractor/Plumber —Pipe Material A ELS <br />□ Right of Way Cut ^Permit Required <br />Installation Date — <br />PwmMon amnM to attach prtoota <br />Date of Issue V"Pipe Diameter. <br />□ System Development Charge <br />i o. da 55 €-Inspected By <br />connactha to pobOc <br />Public Wastewater Information <br />Index Page No. <br />q Lqg qfqB-f <br />Upstream Downstream25"Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />/ <br /><—87 —> <br />\d <br />, ?