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?;h <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 />r>r. <br />XirQ)ryK\ Prcftgr-t/e.r Ent. <br />Building Type: □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Fwrmbtkfi gmM to attach pftvata <br />n-oaHHM-oi Date of Issue ~ 1 "7 <br />Pipe Material Pipe Diameter,^_. <br />/ • <br />1x^14 <br />□ System Development Charge <br />H - 1.^- 1-7 Inspected By <br />kt contormhanco to Oty ttandardt and apocMoattona.connection to pubac <br />Public Wastewater Information <br />SI <br />Inspected^By . <br />Segment No.Index Page No.Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />T <br />Tap <br />"T <br />1 <br />t <br />i <br />v? <br />I <br />2 Q 13l <br />y?