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I <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenis, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address _____:__Porilamrl 5f <br />Mari4. Ho-r-hx Siet^JarcI <br />Map and Tax Lot___: <br />Building Type: <br />--------------------------:--------Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. _ <br />Or>ntrnntnr/Plnmhf»r <br />□ Right of Way Cut Permit Required <br />Installation Date <br />/'mn/m/on grantad to attach prtvata <br />Date of Issue r^~~7 - H <br />Pipe Material $Ch Pipe Diameter^ <br />«/ <br />□ System Development Charge <br />La C/x SS£\M-\^Inspected By <br />ccnnacdoa to pobtk amr h ccntormnanca to Oty ttandardm and •ptcMcaticn*. <br />Public Wastewater Information <br />Index Page No 1 Segment No. <br />nspected By <br />J733 <br />Downstream Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344t <br />N <br />A- <br />i <br />i <br />i. <br />t <br />30 <br />\r <br />, 1.