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fN>*?•- <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 ____:____Roy^l Ave. <br />Bc~th ( £ cr h nA j ID i'si:Map and Tax Lot <br />Building Type: □ SFD □ Duplex □ Multi-Family ^Commercial □ Industrial <br />Owner <br />Permit Informat on <br />Permit No.'q-oggq7-^i <br />Contractor/Plumber-LjCAC^. rJ <br />Date of Issue l ^ t f/ <br />Pipe MaterialDiameter^ / b <br />□ Right of Way Cut Permit Reauired <br />Installation Date __/ <P '(ST ~ i_l <br />Pwmimicn granted to attach pctvoti <br />□ System Development Charge <br />Inspected By <br />h oonformnanca to CHy atandarda and tpachkatfon*.connactba to pubOc <br />Public Wastewater Information <br />Index Page No. <br />ted B <br />^3.&Segment No..Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-23+4 <br />\o o^Wooir <br />K lichen <br />0 <br />0 <br />C5 , <br />H6 <br />oft <br />50 <br />c> tho o?o'/ <br />Prv. MH.MH. <br />Proxie F\+n.School <br />4