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Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenfe, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot__ <br />iLTff Cre.r^hnuN Rj <br />Owner <br />Building Type: ^SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. I ^ ' OO^OO " O (________Date of Issue .. . <br />Dootrnrtor/Plumhfir ^ I .5 Pipe Material Pipe Diameter_l <br />□ Right of Way Cut Permit Required <br />Installation Date <br />rwmlmhn aranM to attach prhott <br />• t <br />□ System Development Charge <br />LolCa sseInspected By <br />connactioa to pubtc —-*r *i confoimnancm to Oty rtantfarda and tpacMcotiona. <br />Public Wastewater Information <br />Index Page No.Z(*Segment No.-J^^P Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />T <br />-6)-^ <br />(o <br />® *\ro