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bbl\b\h ■I <br />Public Works <br />, MaintenanceUSS&S Conn^CAN'.V “ ■1820 Roosevelt Blvd. <br />Euqend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address -------:--------- <br />Map and Tax Lot------ <br />Building Type: ■ SFD <br />\Slb <br />___________^ ,__Owner <br />□ Duplex □ Multi-Family □Commercial □ Industrial <br />Permit Information <br />Permit No. bj__ <br />Contractor/Plumberj_ <br />□ Right of Way Cut Permit Required □ System Development Charge . ' . <br />Installation Date ^ / --------------- . Inspected By o ^ <pT V <br />PtmtMon a-onM la <rttoch prMa **ir«r cannacUoa to ptMk T h conformaanc* to CXy ttandardi and ipocilhatian* <br />Pipe Mntftrinl pjpe Diameter.-^.. <br />Date of Issue <br />\ <br />Public Wastewater Information <br />Index Page No- <br />Inspected By23mSegment No.Contract No.Upatfeom <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />l <br />J <br />IS'2V I <br />i <br />I <br />il+o <br />yt <br />[o'2 / <br />i 5 <br />"'V <br />21 wnin\NeV\f\LtfV\D^ 22H4 O N-o