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bbbHS <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 />3QgO LaKp larid h\)6L. <br />PaouA He beK(° <br />Building Type: ^TSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date <br />rwmimion granted to attach ethnta mow conoactlom to pU*c <br />Date of Issue <br />Pipe MateriaL <br />*/ <br />HPipe Diameter. <br />□ System Development Charge <br />h-an - iq Inspected By <br />h cantormnonco to CXy ttandarda and wpacMkathna. <br />Public Wastewater Information <br />Index Page No. <br />Inspected By - <br />\1H11 IHTO) <br />■" Downstraam51Segment No.Contract No.Upstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-3J2-2344 <br />L .vY'r lanrl 4 VS. <br />1T \Lnoo <br />life'*/ <br />3O iS <br />(o