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bb^bE)h <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 . _:—1:------- <br />Map and Tax Lot — <br />Building Type: 9 SFD <br />npx tvsdm <br />\ I LLC______________:_____Owner <br />□ Duplex □Multi-Family □Commercial □Industrial <br />Permit Information <br />Permit No. _ <br />Contractor/Plumber_ <br />□ Right of Way Cut Permit Required <br />Installation Date W j 'H / ^---------- <br />Pamkdcn granM la attach priJafa <br />________Date of Issue ^ J( <br />^ ^ Lcy3ylA Pipe Material—SCiiiiD- Pipe Diameter !>.. <br />□ System Development Charge v <br />. Inspected By <br />connactfoa to pubtic —war h conformnanca to Oty Handardw and tpacHhcMn*. <br />Public Wastewater Information <br />Index Page No.— <br />Inspected By <br />'ZMoSegment No.earn Contract No.DownstrUpstreom <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-3J2-2344 <br />|U') <br />[ <br />TT ©5—5“ <br />/^7 <br />p- zqgbT <br />qo'2300b23005i <br />I oari