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■i <br />i <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 ____j__;__ <br />Map and Tax Lot — <br />Building Type: 0 SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />"liU TSSoN L-tsi <br />Owner <br />Permit Information <br />Permit No. Ob\l3~7'" <br />n^nlrnrtnr/PlumhRr ^ f^\ LO ft <br />□ Right of Way Cut Permit Required <br />Installation Date ------- ■ T . ---------- <br />rwmlmian granted to ottocfi pfivai* <br />0^/6 <br />Pipe Material 'l~~‘ 0_Pipe Diameter ^ <br />□ System Development Charge <br />Inspected By O t \ ____ <br />h canformnanc* to Ctty otondanM and tpocftkoHono. <br />Date of Issue <br />ccnnoctfon to pob/k <br />Public Wastewater Information <br />Index Page No. <br />Inspected By <br />DownstreamSegment No. -2u Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTtUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />Ll <br />I <br />1 <br />I <br />a 40' <br />*!