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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 />Hoi S’ feilha.vln Rd- <br />D r //q^Owner <br />Building Type: □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber H -------- <br />□ Right of Way Cut Permit Required <br />Installation Date ____^ ~6'3^ . <br />aranM to attach pchata <br />n-o^io -o/iQ-n-BDate of Issue <br />Pipe Material- <br />• / <br />VSchMoPipe Diameter. <br />□ System Development Charge <br />1~£L (LaInspected By <br />to Otyitoxforda andtoIn <br />Public Wastewater Information <br />Index Page No.—4—4 Segment No.- Contract No.DownstreamUpstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />f <br />- <br />-I <br />£ <br />•n <br />, ?.