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bbb^i <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 />15^3^ Dr. <br />8/ure. U3«ccVier-fOwner <br />Building Type: ^^SFD □ Duplex □ Multi—Family □ Commercial □ Industrial <br />Permit Information <br />Permit No._______________________ <br />Cnntmctor/Plnmbfir -5 lCTDV> <br />□ Right of Way Cut Permit Required <br />Installation Date _____f ________ <br />^-oano-oi Date of Issue____________ <br />Pipe Material ^C.h Pipe DiameterJl/. <br />11 <br />□ System Development Charge <br />Lg.CetSS£_Inspected By <br />ccnr*ctk>a to pubtfc hPwmMon granM to attach private <br />Public Wastewater Information <br />Index Page No.Upstream 'DownstreamSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALI UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />T <br />(o N, <br />13' <br />O-rt-isfe'd^eP <br />i <br />n(51, <br />fjehalem Dr