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bb'bc6') <br />rr—--------:---------- <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connectio scAtmpp 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />mi <br />Property Information <br />Address <br />Map and Tax Lot__ <br />Building Type: ^SFO □ Duplex <br />am <br />l-fi0'revo\ An-frn^iol i/0Ownerr <br />□ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. 1 Cj-03GbLl 'O I <br />Contractor/Plumber (jQTXjf.y)/lb <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PwmMon aranM to ettoc* cvftofo <br />4-i>-n <br />Pipe Material ' Pipe Diameter_!± <br />Date of Issue // <br />yriSoh <br />□ System Development Charge <br />LaCasseInspected By <br />*i conformnanco to Oty ttandardt and tpocMkation*.connection to pubBc <br />Public Wastewater Information <br />Index Page No..—(o o^ <br />, Inspected By65^1 for 4oSegment No.Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />\o V?k<4 <br />o 7 <br />4“a <br />To 2H3 <br />II <br />. i.