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t-h <br />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 />Building Type: <br />I55g i fa <br />firur e, ( >l) c h/°rf <br />^SfD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. D - O ^ 90-Q I <br />Con tractor/Plumber <br />5-30-30Date of Issue '/ <br />Pipe Material - HO pjpe Diameterj/ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Pwmhtkn granted to attach prhota <br />□ System Development Charge <br />L-a (L a <br />h conformaanca to Oty atandanti and tptcMcathnt. <br />£H7 - 9io Inspected By <br />cannacHoa to ptMte <br />Public Wastewater Information <br />Index Page No— <br />spected By . <br />Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />/ ^iS S'-deef <br />|5 <br />i <br />i <br />'V-Oi