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•tf <br />t, <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugeng, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:—:— <br />Map and Tax Lot — <br />Building Type: ^SED □ Duplex □ Multi-Family □ Commercial □ Industrial <br />”7/; / L/i'¥ <br />Owner <br />Permit Information <br />Permit No. I ^ ~ O 880l~_.O L <br />Contractor/Plumber H Log. <br />□ Right of Way Cut Permit Required <br />Installation Date ------7 7^ ^ . -Q-P- <br />la-si-n <br />Pipe Mntftrinl SC-h.^^ p,pe Diometer—^ <br />□ System Development Charge <br />l-OL-C,A$>s-e^_______ <br />h centormnancm to City ttandardt and iptctlfcatfon*. <br />hDate of Issue <br />VY\ <br />Inspected By <br />PtrmMan gnnM to attach prtmt*contfcVoa to pubOc <br />Public Wastewater Information <br />Index Page No—3. H <br />Inspected By <br />Zn\3~ <br />DownstreamSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />! <br />! <br />JL <br />& - s15 <br />V? <br />I <br />( <br />I <br />4r <br />i is-) <br />, i.