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Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugen6, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ___j____ <br />Map and Tax Lot__! <br />Building Type: <br />"SOfo L/i, <br />^SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. _ <br />Contrnctor/PlumhRr -SanJ H__V-Od WT <br />□ Right of Way Cut Permit Required <br />Installation Date __ <br />rwmlmhn granM to attach prtvata <br />Iff-OTVgq-O I <br />Pipe MntfirinI Sr.h. ^0 Pipe DiameterjrL. <br />Date of Issue // <br />□ System Development Charge <br />La CaSS<t/-<?;?- iq Inspected By <br />i» conforvnnanco to CXy ttam/anta and wpodthaVonM.connoctfoo to ptMk <br />Public Wastewater Information <br />Index Page No. H <br />Up stream Downstream ^Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTtUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />fyson Ln. <br />'V <br />Vs3°"/'(o <br />4' <br />o <br />33 <br />!