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bbm3 <br />* <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenfi, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address —;—:—:----- <br />Map and Tax Lot—Z <br />Building Type: <br />Pl, <br />SicgeJ--------------------------:--------Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No.__ <br />Con tractor/PI u m b er_^kUQa <br />□ Right of Way Cut Permit Required <br />Installation Date ___ <br />Ptrmktkn oranM to attach prtvata <br />^-OMSG -Ql •iDate of Issue <br />Pipe Material <br />□ System Developmen <br />Inspected By _____ <br />to contormnanc* to Cfty and wp+cMfcrffoo*. <br />U <br />Pipe Diameter_LAcVt <br />i a-to-n <br />ccnnoctioa to pobOc <br />Public Wastewater Information <br />Index Page No. 1 ^.1 b Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />« <br />3 e <br />H- <br />/ <br />t