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•r' • <br />Is 1Public 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_JI <br />Building Type: ^H^FD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />~7 (—p. <br />^ncldUe LLCOwner <br />Permit Information <br />Permit No. <br />Contractor/Plumb <br />□ Right of Way Cut Permit Required <br />Installation Date ------7-J_j--------------- <br />PwmMcn pmM to attach prhato mm* comaetho to puMfc mmr h conformnanc* to CKy rtandord* and tpadlkaVan* <br />1^-054^-01 <br />^PCrhMQ_Pipe Diameter_lf__ <br />Date of Issue <br />ITT A ^ycAQ<i4ifOn Pipe Materialpr <br />□ System Development Charge <br />Inspected By La C r. <br />Public Wastewater Information <br />Index Page No- ■~'i 7----- Segment No. <br />Inspected BL13 Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />(■ V? I £ <br />n <br />i <br />t <br />T <br />I'u'fJeZ+UCCa- Lp. <br />, i