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btk'ii , <br />Public Wpri<s <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend,- Oregon 97402 <br />(541) 682-4800 <br />. •, 'C. <br />Property Information <br />Address '_:_Lj__:__ <br />Map and Tax Lot__ <br />Building Type: m SFD <br />T__.Owner <br />□ Duplex □ Multi-Family □ Commercial Q Industrial <br />UuiaJ^~T/IMT <br />Permit Information <br />Permit No. j______________________ Date of Issue ' Z l 7 ^ / i "'I <br />nr.ntrnntnr/Pliimhpr'ba^'IlKl (^Iw-lbpipe Material’Pipe Diameter <br />□ System Development Change '' % <br />Inspected By .lr'iSl <br />connvMvi to pobtk ww *i conformnanc* to CXy standard* aid iptcMcatfoni. <br />13 Right of Way. Cut Permit Required <br />Installation Date 0 '/ . ■'XC'i----------- <br />Pamkdon yronM to attach private <br />Public Wastewater Information . Inspected By <br />Segment No. ' ----------i noIndex Page No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />10-3." <br />h " <br />31 2-S _ CO <br />/_3^h S»DG VJal-IA, <br />! <br />I <br />l-°\ loJM <br />|lo5C5 0------)■/»I <br />} <br />V <br />/\ LDER St