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% bb3>5°t. <br />i X <br />Public Works <br />MaintenanceLocation of Vi <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugeng, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot _Z <br />tip’von <br />Owner ____:___________:______ <br />Building Type: ^"SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. ______13-0574^^1 7-17-/? <br />C.nntrnntnr/Pliimh^r■ 7 ' '■ ■' '' i'- ^ ^ T’lpn Mntprinl Sch. HO <br />□ Right of Way Cut Permit Required <br />Installation Date ___— <br />PtmUtion granted to oitoc/i prtvoto <br />Date of Issue H.6Pipe Diameter./ <br />□ System Development Chargeq-ao-i'g Inspected By <br />ccoMctioa to pubOc h conformnonc* to Oty rtandontt and tpoc/tkatfona. <br />Public Wastewater Information <br />Index Page No.51 Segment No.Contract No.Upstream <br />f THO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />P^,\/0Y^ fiwJC..____________________________Aw/IS <br />I