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1; <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connec 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ' ■ •__~7// A{qo\t\ AVe. <br />-Hornet LLC <br />SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Map and Tax Lot. <br />Building Type: ^ <br />Owner <br />Permit Information <br />Permit No. <br />Contractor/Plumber ^ ^ <br />□ Right of Way Cut Permit Required <br />Installation Date ________!___:_________ <br />H-omw -ol Date of Issue___________ <br />Pipe Material Pipe Diameter_n <br />it <br />□ System Development Charge <br />L-Q-C.^Inspected By <br />contycVoa to ptMjo mmr k ccntormncncm to <Xy ttandanh and ip^c/lfoaihnm.PwmMon gnx>M to attach prfvoft <br />Public Wastewater Information <br />Index Page No.. <br />spected By <br />DownstreamSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />Ji& <br />I <br />I <br />nit is G^deeP <br />aw <br />Ave.