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!S-\ <br />i. <br />1i <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 />Dr1520 .T&hrt Da <br />L h H y iamd <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. O&SHS ~QI <br />Contractor/Plumber <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PwmMon arait*d to attach prtmtt <br />9-26uL9______Date of Issue <br />Pipe Material A ^h"C Pipe Diameter <br />□ System Development Charge <br />Inspected By ____/-a. Cq$SC <br />h conformnonot to Ctty ttondanta and tpacMcatfont. <br />cj <br />connacOon to puNk <br />I <br />i.