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!*-■ <br />.f <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 <br />3373 Or <br />Qiuf.Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber_B^kOvO_ <br />-io-m\c\-C><2c]aLi'0)Date of Issue____________ <br />Pipe Material ^Ch-HO Pipe Diameter_7 <br />'/ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PwmMon gmnM to attach prtvata <br />□ System Development Charge <br />UiCaSSeI-/O-30 Inspected By <br />h ccnfomtnanc* to Oty *tan<hrxti and tpocHkaVont.connactfoa to pubOc <br />Public Wastewater Information Inspected By _ <br />upstreqm Downstreom11Segment No.Index Page No.,Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />N <br />t <br />MS <br />N/ <br />13e w15tL'5 t <br />Pc. <br />, £