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lyb Sbi!k <br />?!t. <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----1 <br />Building Type: <br />ntSSy Ln. <br />Rorld_________:_____:_____Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. 1 9 ~ ~7-?—^_!------iz-ay-nDate of Issue <br />Pipe Mntftrinl ,A8o 4"Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date —r^~ 3 O <br />rwmMan gnrthd to attach ptivaia <br />Pipe Diameter <br />□ System Development Charge <br />Inspected By <br />h conformnanc* to Oty Handanti and •pocHkxrtfont.conrucOoa to public <br />(