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t <br />k <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection Nc 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property <br />Address <br />Map and Tax Lot___: <br />Building Type: ^TSFO <br />■ighis Ln <br />~TimV)Pir iir\^ (4 Jl$ <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. \<£,'C>1\~11!~Q f_______ <br />Contrnetor/Pliimher ^ick.__FigJc 'G-'T <br />□ Right of Way Cut Permit Required <br />Installation Date __L1gU ~ l % <br />granHd to attach prhata <br />Date of Issue ^ <br />Pipe Moterinl <br />□ System Development Charge <br />to Ctty itandardt and tpachkationa. <br />// <br />Pipe Diameter. <br />Inspected By <br />to pubOc h <br />Public Wastewater Information <br />Index Page No.,—13-k/. <br />si <br />Segment No.Contract No.Upstream <br />THO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />v <br />v <br />f~3t 1-^i- <br />3$* <br />iy? <br />/Q5 <br />3uvr\m'i\-1^