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MU* .«I ‘i . <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Ulvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />• T» <br />Property Information <br />Address '_____:----- <br />Map and Tax Lot------ <br />Building Type: gj SFD <br />witS^ /Wfc 7 <br />{jWifcfi* ^V\tCToM /\ «Avtxo:0v/ner <br />□ Duplex ' □ Multi-Family □ Commercial Q Industrial - <br />Permit Information <br />Permit No.Date of Issue Of/'Ob j2~0 <br />Contractor/Plumber Pipe Material A -------I <br />□ Right of Way. Cut Permit Required <br />0\ l0 & (lo <br />20-000^1- o\ <br />Pipe Diameter-^. _ <br />□ System Development Chayge ' • . <br />Installation Date <br />Pamfnlon fmnM to altoch prteit*h contorm/Hxic* to Oty iian<ford*codn*cU0n to pubBc <br />Public Wastewater Information. '• Inspected By <br />Index Page No. W?------ Segment No.-^^----------R.Ctr^'Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-BOO-332-2344 <br />W2S™ /We <br />i <br />i <br />6 8’ <br />\l'i <br />/\ <br />9f-2“ <br />Lo^3 % <br />i ^ib i <br />I <br />I <br />i•^\7 foi&<:----V 211% <br />3ni 3m