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bbbV)t i <br />5 <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenfe, Oregon 97402 <br />(541) 682-4800 <br />Property Information ^ ^ . l o I <br />Address -^OO CoOf\jr^f C-UD tsq______________________ <br />Map and Tax Lot__________________________Owner UlC <br />Building Type: □ SFD □ Duplex □ Multi-Family Commercial □ Industrial <br />Permit Information <br />Permit No. \7~Ql <br />Contractor/Plumber ^------ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PwmMcn gmnM to ottoc/i prtvoto <br />Date of Issue <br />Pipe Material H <br />•/9Pipe Diameter. <br />□ System Development Charge <br />Inspected By ___ <br />to canformnanc* to Oty ttandardo and tpocMkxiHona. <br />\-ISOlO <br />connoctfoo to pub#: <br />Public Wastewater Information <br />Index <br />Inspected By - <br />Page No.iiWH- Segment No. ------Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />T.43'£i(d <br />4/ <br />pO>v\t5 <br />f/eu) C<»!rtec+/o^ poiirT <br />il <br />I <br />// <br />i <br />, (