bbL> Zl\fN‘ <br />•P' • <br />>7i <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—H <br />Building Type: ^hSFD <br />I______________:_____Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. I ^ * 03-iO ~ Q i_______Date of Issue ______ <br />ronfmotor/Plumhor Oq>r| ^ Loa.yy^____pjpe Material.Pipe Diameter^ <br />4-3-H U <br />□ Right of Way Cut Permit Required <br />Installation Date ____—~ ! i::] <br />PomfcWow grant*/ to attach pstvoi* <br />□ System Development Charge <br />Inspected By <br />conMcttM to poMc —wtr h ccnform/tanc* to CHy itandord* and $p*cMcatian*. <br />L<xCd5£r° <br />Public Wastewater Information <br />Index Page No. <br />Inspected By _OScei '33cb&Segment No.Contract No.DownstreamUpstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />/h nn'N <br />N 37 <br />I <br />! <br />, i -