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bb%b <br />i'l------------------------------- <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 _;__j—:----- <br />Map and Tax Lot----- <br />Building Type: B SFD <br />STsRuMCi \MQ0DS LX <br />~To>n \A)£r\-£<^_______________:_____Owner <br />□ Duplex □Multi-Family □Commercial □Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumberj__(.!><>A l/Kl—i— <br />□ Right of Way Cut Permit Required <br />Installation Date _ <br />PtrmMan oranM to attach <br />___Date of issue '- )C\(Z- *3/ ^ <br />,___Pipe Mntprinl Pipe Diameter <br />e ' » *□ System Development <br />Inspected ByU /lu/l^ <br />prtvata w*nr cvnnrcifon to pobth <br />Public Wastewater Information <br />Index Page No.. ^1- <br />Inspected By2ZlSl iSlbXlpslreom ' DownstreorrSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DK5, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />1 <br />IT-L" <br />I <br />- <br />tt <br />s' <br />I t <br />I3o i <br />Ia ^-O <br />i <br />STeRlW WOODG DiR2T\%io <br />>N