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bbb'h I ,? *. . <br />I- <br />jfc,. Public Works <br />Maintenance <br />•Hi820 Roosevelt Blvd. <br />5r Eugend, Oregon 97402 <br />(541) 682-4800 '• <br />Location of <br />Wastewater Connection CMymf <br />• <br />.Ti1 <br />Property Information <br />Address _'• — <br />Map and Tax Lot------ <br />Building Type: □ SFD <br />L *'• vx <br />7SUS (’a-r-KH ZT -A,V <br />_:________^ ____.Owner <br />□ Duplex □ Multi—Family □Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber; <br />□ Right of Way. Cut Permit Required <br />Installation Date <br />PefmMan oronM to oHocfi print* —w ccotvclfoa to poMc <br />Date of Issue f <br />Pipe Material.. £^1140__Pipe Diameter,, j. _ <br />□ System Development Charge ,. . <br />. Inspected By L\ 0^^ ^ <br />h ccnhrmnak* to CHy tiarxkrdw aid tptcHMhn*. <br />\!\\lZo <br />Public Wastewater Information <br />Index Page No.J-^t-L— : <br />; ^ Inspected By <br />Segment <br />TW WORKING DAYS BEFORE YOU WG. CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />Contract No. <br />I <br />i-t:i <br />Lf'i <br />1 <br />6-tt <br />n .> _i <br />i <br />i <br />! <br />IAu <br />i <br />! <br />N✓ <br />o <br />i <br />HoiSa-r-<-------O <br />\