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bbSSS <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 />1^03 FilKhflrn Dr. <br />Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Informat on <br />Permit No. __t_____ <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date <br />iq-OlHSl-Pt /a-aa-n <br />h M o <br />Date of Issue <br />Pipe Material <br />n <br />DiameterJ__T.TVs Pipe <br />□ System Development Charge <br />1-30 Inspected By <br />cconvMoo to pobttcgranted to attach prMu <br />Public Wastewater Information <br />Index Page No <br />BIn si]o5c7 iSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />l\l <br />'/€ <br />i <br />5 i <br />i <br />'V <br />cp^l <br />, !