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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 •__:___ <br />Map and Tax Lot___I <br />Building Type: ^fSFD <br />L-n ■Tv V)l/1 <br />'In'udtPtn. HotrifS <br />□ Duplex □ Multi-Family □Commercial □Industrial <br />Owner <br />Permit Information <br />Permit No. i ^ ' 0\SOl-Q) <br />Contractor/Plumber^Anj M L <br />ftDate of Issue <br />Pipe Material. <br />□ System Development Cfc) <br />Inspected By La. C <br />cccn*Moa to pubOc mwor h conformnonc* to Ctty Handardm and wpoc/tkation*. <br />Pipe Diameters <br />arge <br />a.zse <br /><*» Wa <br />□ Right of Way Cut Permit Required <br />Installation Date LT~ ' 1H <br />Pwmhoton arantod to attach print* <br />Public Wastewater <br />Index Page No.—- <br />Jn formation ^0tlnspe^^ <br />Upstream DownstreamSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />N <br />W ,3 »5"s:7c <br />33 <br />! <br />/ <br />/ <br />. t