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bbb$b,f*- <br />5ai <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />fiprryProperty Information <br />Address ——_i—:----- <br />Map and Tax Lot------ <br />Building Type: ^^SFD <br />Cac\ <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. | ^ "OS&SS'Of <br />C'<xy\A R <br />Date of Issue 1^ „ ,, <br />Pipe Material Soh-HD__Pipe Dinmetftf^ j VContractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date ___^ <br />PwmMan granM to attach pffvot* <br />□ System Development Charge <br />Inspected By <br />eonnoctfoa to pubOc mwtr h contormnanco to CKy ttandan* and •pocttkailon*. <br />l—fl ( <br />Public Wastewater Information <br />Index Page No—\el~lA <br />Inspect^MBy <br />Segment No.Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />N <br />to#—11 <br />i <br />£ <br />•• u <br />vO <br />0>~ <br />A6S