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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 />Building Type: J^SFD <br />/5/3. N^-tocc.g Ai/e. <br />SnrJa.l/e <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />LLCOwner <br />Permit Information <br />Permit No. <br />Contractor/Plumberfc.XCAU&lv'' Pipe <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PtrmMon granM to attach pfhato <br />il-osask-oi Date of Issue <br />Material-Pipe Diameter. <br />□ System Development Charge <br />L-£l C-^Ct 'Z'&CInspected By <br />to aty atxMxMa andto put/fc <br />Public Wastewater Information <br />Index Page No.Upstreom Downs tfeotnSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />Yf <br />/ <br />37 <br />r <br />CP <br />v?