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bb'Al'b'f;•Ii <br />Public Works <br />MaintenanceLocation of ^ A K IKICT <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenis, Oregon 97402 <br />(541) 682-4800 <br />•f <br />Property Information <br />Address _____:_____ <br />Map and Tax Lot------ <br />Building Type: gj SFD <br />bbl 'TvfS.0K\ <br />----------------------------:_____Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information\4- oyofe-fc>\ <br />Contractor/Plumber ^ ^ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PwmJmkyt granted to attach arhata <br />oft/zyiqPermit No.Date of Issue. <br />Pipe Material_______ <br />Ol. <br />Diameter oPipe <br />□ System Development Charge •. » <br />Inspected By\0/\87l^ <br />tf confarmnanc* to Oty ttandanh and <br />Public Wastewater Information <br />Index Page No.- <br />_ Inspected By <br />Segment No- eqm . - D5wn3treom?>U Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />» <br />|Fb‘A'SrO-- <br />2.7-5* <br />( <br />■ <br />t <br />TTfeln' JL’ <br />6i'i <br />Ml'I <br />o o•71''21011 11oi\ <br />l