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bbS^l A <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: ^fSFD <br />3 I IS in a <br />V/ I <br />On.K PL. <br />Owner <br />□ Duplex □ Multi—Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber . ^ — <br />□ Right of Way Cut Permit Required <br />Installation Date -----Hs/S'o^O <br />gmnM to attach prlvota <br />Z-9-Z-3Q <br />.qf.h.WQ <br />ao-oi^n-oi Date of Issue <br />Pipe Material- <br />□ System Development Charge <br />Inspected By __L a <br />> / <br />Pipe Diameter. <br />to Ctty ttandarda andhto pobtfc <br />Public Wastewater Information <br />Index Page No..UpsVeqrn Uowrv3treornSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />N <br />V? <br />HO <br />V'fc \|(?/ <br />H'detp Irit ^ <br />10 <br />I33 <br /><—is'-^ <br />i ■