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?7i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />S 'nf^°n3 4H Archi'r <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Map and Tax Lot <br />Building Type: ^SFD <br />Owner <br />Permit Information <br />Permit No. _____- - ________ <br />nnntmntnr/Plumhp.r fjrAvWV <br />□ Right of Way Cut Permit^ Required <br />Installation Date ____~ __ <br />^0-o^S2-0\Date of Issue V /V <br />Pipe Material HO pipe Diameter^L <br />n <br />□ System Development Charge <br />La C r. <.ceInspected By <br />h cooformnonc* to CXy otandonio and mocHkadono.Pormktkn granted to attoc/i prfvoto eotmocbon to pubOc <br />Public Wastewater joformation <br />Index Page No.Upatreom Downstream'Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTIU7Y ONE-CALL SERVICE AT 1-800-332-2344 <br />N <br />3^\ <br />34Hjsr- <br />i <br />i <br />i <br />'-/ih--P.5.E. <br />•4> <br />3^-V V® "■ 3Pi i <br />i <br />^53'-^V