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bbs^!- <br />Public Works <br />Maintenance______ <br />1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Location of <br />Wastewater Connection <br />Property Information <br />Address —:—:--------- <br />Map and Tax Lot------ <br />Building Type: ^TSTD <br />^ 73. -S~fe.rlii4^ WooJs_____________ <br />—ffwn^r Kairiy)a. W6S~fer~ <br />Pr. <br />□ Duplex □ Multi—Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. 19 - O ^ 9 ^ 1___1-2-20Date of Issue If <br />Pipe Material Cgl-h-WO. Pipe DiameterJl/. <br />□ Right of Way Cut Permit Required <br />Installation Date ------^ ~! I ~ 20 <br />Pimktkm grant*! to attach pfhota <br />□ System Development Charge <br />Inspected By L-<x.C.a*>£e. <br />to City itandanti andhto <br />Public Wastewater Information <br />Index Page No—1 <br />Inspected By - <br />Segment No.Contract No. <br />DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />'/«K)f12 3H Vg <br />ft i Vg7'dleep <br />l