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bt>^\J,■I <br />4 <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 />+c <br />XV)c- <br />Building Type: ^TSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. Q\__ <br />Contractor/Plumber —t4._L-0-^rrV\ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Date of Issue t ^^ <br />Pipe MaterialPipe <br />( I <br />Diameter^. <br />□ System Development Charge <br />-a. CgInspected By <br />*i canformnonca to Otv itandarcto and tpocHkotfon*.conaoctfon to puMcPtrmMon grantod to attach prtmt* <br />Public Wastewater Information <br />Index Page No.;j.<rfected By <br />Upstreom <br />HQ Segment No.Contract No.Downstredm <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />t <br />-t <br />i <br />y? i,7 <br />i\K <br />/ <br />t.