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■e' <br />S'. <br />i <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 />W3S~ Linrlle^ Ln. <br />Ha*' K bnV\-------------------------------Owner <br />FD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />6 <br />Permit Information <br />Permit No._i <br />Cnntrnntnr/Plnmhftr « <br />□ Right of Way Cut Permit Reguired <br />Installation Date ___^ <br />rwmhtion grant*/ to attach prtvata <br />ill- niq-oiRK-oi '/Date of Issue <br />Pipe Material 7ipe Diameter. <br />□ System Development Charge <br />La (La.$Se.//-/a'ii Inspected By <br />oorractfcw to putOc t h conformnonca to CHy ttarxford* and ydWbaflbn* <br />Public Wastewater Information <br />Index Page No. <br />Inspected By <br />\OeZ Segment No.—ICLQId Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE—CALL SERVICE AT 1-800-332-2344 <br />3 » <br />h" IN 66■& <br />\ 9 kv *YY*-k<v <br />H <br />SO’ <br />& <br />V €0'0 <br />5- <br />igcvo (/'3^3N <br />/ <br />i .