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5<V3 <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: <br />3^6^ Hea'Lher (oro\/t Lrt. <br />Brute, U )ie.c,htri~Owner <br />□ Duplex □ Multi—Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. ______=-----—=----------- <br />Contractor/Plumber------ <br />□ Right of Way Cut Permit Required <br />Installation Date ----------H — <br />80-01522'Of 7-13-20Date of Issue <br />Pipe MaterialPipe Diameter-^ <br />□ System Development Charge <br />LclC,q S£<Z—Inspected By <br />to CHy standard* andhto puttieyqitorf to attocH privoto <br />Public Wastewater nformation <br />Index Page No.UpstreamL 1 Segment No.Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />Kl <br />1 <br />,5 <br />[ <br />33'£ <br />1 <br />7?V/^1 <br />■ ?