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bbb'b'l'■f <br />%! <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenC, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:----- <br />Map and Tax Lot_ <br />Building Type: <br />3SS3 NWtV <br />(^ya^Ioh/P LLC <br />FD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No.n-owan -o\ <br />Contractor/Plumber Pipe <br />□ Right of Way Cut Permit^Required <br />Installation Date ------- <br />Parmktkm grant*! to attach prfvatt <br />I IDate of Issue <br />Material. <br />□ System Development Charge <br />Inspected By <br />h ccnformnaoc* to Oty atondorda and tpaef/kodon^ <br />wSc.V\,HO Pipe Diameter. <br />connactha to pubttc <br />Public Wastewater Information <br />31 <br />pected By <br />DownstreamIndex Page No.—^2 Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />9 <br />& <br />\n r <br />0 <br />I?' <br />x <br />V <br />^Jesi^ccct if.