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ItbSH'] <br />S’, <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 />ma Pl <br />'SaMfS l-lnwifs L-Ld.Owner <br />SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. o)C> -^D^j _O I___ <br />Contractor/Plumber. Cfao/\—E^KC-. <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Date of Issue c?~3 '<PO if <br />VPipe Diameter-Pipe Material <br />□ System Development Charge <br />La. C-a.$S€.IL>-aO Inspected By <br />fo Ctty rtandardw andhto putOcto attach p/tfoto <br />Public Wastewater Information <br />Index Page No..— <3(q <br />Inspected By -------------------------/m/ /loss- „ . . ..---------------------fownsfoom- Contract No.Segment No.Upstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />'V <br />. ?