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bb^O <br />I 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-----1 <br />Building Type: ^-SFD <br />_______________:__,__Owner <br />□ Duplex □ Multi-Family □Commercial □ Industrial <br />Permit Information <br />Permit No. Ol 1 C\~J'Q l— <br />Contractor/Plumber C fliiCl —.— <br />□ Right of Way Cut Permit Required <br />Installation Date —J& "'•V ! ' / Cl.----- <br />r^arMon ervnM to ailoch pfivaU »rrw corwrtfon to pubOo nwtr h cenkrmmnc* to Oty tiandorda end ycfflarifcn* <br />Pipe Material Pipe Diameter^li. <br />Date of Issue // <br />□ System Development Charge <br />La. eInspected By <br />Public Wastewater-Information. <br />Page No., 10-LSegment No..n<i7£s?(icy$s' <br />Upstreom eowntlrtcmindex Contract No.___I <br />S~7 /—o1^H' <br />H-iS 4 Jeep <br />l~i V>eio 40 <br />/ <br />5 <5 Con.nee/{- Lo <br />ews4f*g37 c..*.