5; bbS^ftl. <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: <br />RnierMieu); A Rhitiruif u) <br />uJillawern0Owner <br />^SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. ) ^ ? ~Ql <br />rvinfr^*^r/P||imhpr Prec?sfc>*o P/uryiA^pipe <br />□ Right of Way Cut Permit Required <br />Date of Issue /<9 / ? <br />Sc/? Vo v"Material Pipe Diameter. <br />□ System Development Charge <br />C-QInstallation Date IQ <br />Pwmhalco granted to attach prtvat* <br />Inspected By <br />h conformnanca to Ctty atandarda and tpacNkatfana.cennactha to puNk <br />Public Wastewater Information <br />Index Page No.r 119.Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />IW <br />2 <br />Qj <br />> <br />cu <br />t <br />DC