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t ■- <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugen6, Oregon 97402 <br />(541) 682-4800MhlED <br />Property Information <br />Address _____j____ <br />Map and Tax Lot_I <br />Building Type: <br />Bruip----------------------—_—,— Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. _______ <br />Contractor/Plumber Pipe Materinl <br />□ Right of Way Cut Permit Required <br />I‘T 04503-01 Date of Issue / • <br />4Pipe Diameter. <br />□ System Development Charge <br />Installation Date <br />Pwmi—icH fronted to attach prhata <br />Inspected By <br />*i ccnformnancm to Ctty ttandardm and tpactlkationo.coanactkxi to pubHc <br />Public Wastewater Information <br />Index Page No.: <br />nspected _By _ <br />S3^3 Segment No.Contract No.Downatreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTHJTY ONE-CALL SERMCE AT 1-800-332-2344 <br />\H' <br />V/6 <br />9 <br />A isM'd06? <br />3’ <br />/K <br />-30'4 <br />. t