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: kWHa 'i . <br />•i <br />Public Works <br />Maintenance <br />1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Location of <br />Wastewater Connection <br />• r-' <br />AddresJ 'nfDrmgti°n Rp <br />Map and Tax Lot------ <br />Building Type: □ SFD <br />2 <br />______________:__7__Owner <br />□ Duplex □ MultH-Farrvily □ Commercial □ Industrial <br />\Permit Information <br />Permit No. _!07/It?/1 g <br />nr.nfrrqr^nr/Pliimbpr pjpe Materia I ip e <br />Date of issue <br />Diameter. <br />□ Right of Way. Cut Permit Required <br />Installation Date <br />PormMcti granM to attach pftmtm <br />□ System Development Charge <br />Inspected By <br />h ccnformnaric* la CHy ttarxkrdm and tptcHfcaik <br />ooAki12/2,0/ia <br />to pubttG <br />Public Wastewater Information <br />Index Page No..-—^Lrt <br />. _ Inspected By <br />Upstream Downatraom- Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />SENvLA R£>(K)7<^€>0 o —0 <br />1 <br />Te4-7e^Tyz££P\ <br />^ PuU> c y'/ 'iCO •» <br />\/■ <br />I \ <br />\b <br />\v 6\\ <br />fI\\\1 <br />1 1\1\0—^v <br />\■©—A\ <br />\\0^✓ <br />\<!\i <br />V <br />/ <br />vII V <br />I <br />I .II <br />I1__l___..