fob 5^2,■j <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 ~~~7. <br />Building Type: ^/sFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />AueIZ8LUmf-j-iM <br />Dan Heitma mOwner <br />Permit Information <br />Permit No. <br />Contractor/Plumber_Li <br />□ Right of Way Cut Permit Required <br />Installation Date —V ‘—2^ <br />PtunMon omt*d to attach pttmtm <br />9 S'c),QQD - C)0~ld L/ - O I Date of Issue <br />Pipe MateriaL W ''Free v^a k\Pipe Diameter.' WA <br />□ System Development Charge <br />La. CatSSe.Inspected By <br />h conformnanca to Ctty ttandarda and <br />Public Wastewater Information <br />Index Page No. <br />Inspected B <br />HI Segment No.Contract No.•com <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTIUTY ONE-CALL SERVICE AT 1-BOO-332-2344 <br />w <br />& <br />dr’5sl% <br />i <br />.1^ <br />I <br />i <br />i <br />17 tfgyW