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bbL\o3>v <br />Public Works <br />Maintenance<3CANNELocation of ;■ - <br />Wastewater Connecti 1820 RoOsevelt Blvd. <br />Eugend,- Oregon 97402 <br />(541) 682-4800 . <br />•< <br />Property Information ^ ,Address ____. %LH^R°Wy On <br />Map and Tax Lot — <br />Building Type: <br />Bruce. fie, <br />□ Duplex "□ Multi-Family □Commercial □ Industrial • <br />Owner <br />^-SED <br />Permit Information <br />Pdrmlt Nc. iq-O^OOa-gi „ ■ -- , u <br />Contractor/Plumber. -----Pipe MaterialP-HO p;pe Diameter_l <br />□ Right of Way Cut Permit Required □ System Development Charge <br />'S’ ~ 1 *7 __________ Inspected By __ <br />eeiirneVon to pubOo mnr h eaikminak* to CHy wtandanta and ipactlkaticns. <br />(n:\l-R l'.Date of Issue <br />Installation Date <br />PrrmAatcn ernnM to Mocfi prtrtto <br />Public Wastewater -Information-. <br />Index Page No.,—S2—3 2*7t¥> <br />Segment No.Con tract No. <br />T <br />M a <br />i <br />57’ <br />i <br />i-: <br />H'5 ocS<lee?3' <br />I17 0iso'\> $3V>,