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11-. <br />? <br />—i, <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 ____:--------- <br />Map and Tax Lot___ <br />Building Type: ■ SFD <br />------------------- -----: T— Owner ____:___________:______ <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. _W- O02l\-t>\o\/\^/vq <br />Contractor/f^Iurnber__T T_Mnterinl HO <br />Date of Issue <br />Pipe Diameter. <br />□ Right of Way Cut Permit Required <br />Installation Date /l-S / _____ <br />/VinJwfaw granM to oitocti pftvata <br />□ System Development Charge <br />Inspected By \ <br />eenrnMm to pub«c —wr h conform/tanc* to CXy gtandardt and MHcHcoUanu. <br />Public Wastewater Information <br />Index Page No. S~Z Z>^nSpeCiflMya <br />Upstreom bownstreamSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />v <br />v« <br />12L M<24 J E <br />Vlb TVruaVib ^\b'cc !k, • <br />" i U-g" <br />AT-ffflS <br />'DefV'u <br />i <br />6- <br />f <br />»i 72 <br />\i ni \o i <br />Sand <br />o <br />21IUO 2 use <br />. j