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bb^% <br />V <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugeni, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot__ <br />TOOSA Prairip RT. <br />GerAi,lri LlvjriQi^Owner <br />Building Type: □ SFD □ Duplex □ Multi-Family ^TCommercial □ Industrial <br />Permit Information <br />Permit No. lC!-O4a0’8-Ol <br />Onntrnrtnr/Plumhfir HartS^-l) CqVT5. <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Pirmimhn granM to attach prhata <br />Date of Issue l ~7 ' 1*1 u <br />Pipe MaterinlSOS^/^c^.VO Pipe DiameterLL— <br />□ System Development Charge <br />LabsizSe.7-26 -1 Inspected By <br />h conformnanco to Oty ttandarda and apocMcations.ccnnacdoa to putOc <br />Public Wastewater Information <br />Index Page No.[^SpeL^ <br />Upstream Downstream <br />ya Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />5cp^f<1 rL/ a <br />qJ <br />,LClL^7/i <br />33 <br />- bi <br />i ! <br />I <br />i <br />$\ <br />y«v/t <br />Corned e/rs+rnj C.Z. <br />.}