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fS-bbSbb■f . <br />S': <br />i. <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenfe, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address :—:—:— <br />Map and Tax Lot — <br />Building Type: <br />I58S 5ahiiani Au<°. <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 -------U —> -/ ' <br />Pmnlnhn cranM to attach orhata <br />it/Z'/y19 (03404-0 I Date of Issue <br />Pipe Material_fjCh' ^0. Pipe Diameter.V"R & yi (zi H <br />□ System Development Charge <br />Inspected By ____/-a. C-#SS& <br />h conformnanco to Oty rtaKtarda and wpachfcatkxta. <br />I <br />‘ <br />, £ -