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bb5i\% <br />:■! <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 />Building Type: ^TSFD <br />Me. I ±e,bc fc-e~ -----------------------Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information , <br />Permit No. riC) - O] <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date <br />rrnmhtlcn granted to attach private <br />Date of Issue 3 £~^ <br />Pipe Material ^ch-H^ Pipe Diameter__ <br />// <br />Mp I4e.be,ke <br />□ System Development Charge <br />Inspected By <br />>i ccnformnance to Ctty etandarde and epecHkatfon*.connection to puhtfc <br />Public Wastewater Information <br />Index Page No.,n^?pectnfh <br />Upstreom DownstreomaSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CAUL SERVICE AT 1-800-332-2344 <br />NJ <br />tfnvri 7 <br />u' <br />is