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bb£Sb* <br />!'■- <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: /Cf'sFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />John Dny Dr- <br />tffitne boi/der Cun <rJ-r\jcOwner <br />Permit Information <br />Permit No.__j ^ __________Date of Issue <br />n^n^nr-tr.r/Pliimhpr jjfoluvo Ey^avlO-'t^ Pipe Material _-Ch HQ. Pipe Diameter_l <br />'/ <br />□ Right of Way Cut Permit Required <br />Installation Date ------/'C?^~ <br />PimWon granted to aiioch prtvoft <br />□ System Development Charge <br />Lou (CL^Se <br />to CHy ttandard* and ycfltartfen* <br />Inspected By <br />ccocfctk/o to put/Oc h <br />Public Wastewater Information <br />Index Page No. <br />Inspe <br />UpstreamSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />i <br />^ 03/93 i <br />16 <br />V? <br />V? <br />5' <br />4' <br />5? <br />/ <br />, i