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bb5b\?7f <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 />3215 Healhev- I <br />Bruce- (x)iecY)rr'f-Owner <br />SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information . . •. <br />Permit No. 6 <br />Contractor/Plumber__^ <br />□ Right of Way Cut Permit Required <br />Installation Date -----/~ 3 O <br />uDate of Issue <br />HPipe Mfitorinl 5(. Li VO Pipe Diameter <br />□ System Development Charge <br />La.CnS5e-Inspected By <br />*i ccmfcfmnanct la CHy rtandardt and ycfflcofloratcowmcMm to ptMkPmmlMhn aranttd to attach prfrota <br />Public Wastewater Information <br />Index Page No.Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />0^966/T't, <br />w/ <br />31 <br />i <br />, i -