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. Public Works <br />Location of ; • <br />Wastewater Connection <br />Maintenance <br />1820 Roosevelt Blvd. <br />Eugend,- Oregon 97402 <br />(541) 682-4800 <br />•< <br />Property Information <br />Address ------—:— <br />Map and Tax Lot — <br />Building Type: [^§FD □ Duplex □ MultH-Family □ Commercial □ Industrial <br />Ownp.r inr.. <br />Permit Information <br />Permit No. __—1 n-,37-n <br />Contractor/Plumber i^\ LpgyyQ <br />□ Right of Way Cut Permit Required <br />Installation Date -----1,~ \ & ------- <br />) Pvrmhskn pvnM fa atloch T«r ctrrvcVon to pubte »mc h cenfarmncnci to Oiy Handonfa aid tp+XteoVon*. <br />_Date of Issue_____________ <br />_PIpe Material—Sch- HO Pipe Diameter^. <br />□ System Development Charge <br />_ Inspected By La.Get CSC.__________ <br />/ / <br />Public Wastewater Information, <br />s,--48£I|£^ ■ <br />Index Page .No.r-Contract No. <br />t <br />J g. <br />t <br />3' <br />If <br />\b <br />34' <br />4