bbSb'bV <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />^.rrn^hrii,)RcLProperty Information <br />Address ____:_:__ <br />Map and Tax Lot — <br />Building Type: □ SFD <br />Owner <br />□ Duplex □ Multi—Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. ■ <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date ------3 ” <br />Pwrm/nian aranM to attach prhata <br />n-om<r-of <br />Rfdon tyc. <br />//Date of Issue <br />Pipe Material Pipe Diameter. <br />□ System Development Charge <br />Inspected By <br />K* to aty Handarda and wpacHtcadon^cannacOon to puttie h <br />Public Wastewater Information <br />Index Page No-----(Jp- <br />B <br />5Segment No.ontract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERMCE AT 1-800-332-2344 <br />-oc^:\ <br />\ <br />ii <br />31\ <br />£<uu- <br />.«•