% <br />5. <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 />M&aaoul Q^L <br />Me. I ^H________:___________Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Informabon . <br />Permit No. I n' Oil £> l 'O I <br />Contractor/Plumber— <br />□ Right of Way Cut Permit Required <br />Installation Date — <br />PwmMon aranM to attach pchata <br />soKHo <br />)Date of Issue <br />Pipe MateriaL Pipe Diameter.^ <br />□ System Development Charge <br />La da£SeInspected By <br />h conkrmnanot to Ctty itandarda and tpocMbaVona.ccnnactkm to ptMfc <br />Public Wastewater Information <br />£27 UpstreamSegment No.Index Page No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800- <br />m.# 156- deep <br />t <br />I