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i <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: <br />g w\ A\Je^ <br />Owner ____:------------------:---------- <br />^SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information l-io-ao <br />Sc-hMO <br />go-nni~;n-QI Date of Issue <br />Pipe MateriaL <br />Permit No. <br />Contractor/Plumber — <br />□ Right of Way Cut Permit Required <br />2-13-20 <br />nVPipe Diameter. <br />□ System Development Charge <br />L-ou(La.s$e-Inspected By <br />In ccnformnanc* to CXy rtandardt and <br />Installation Date <br />PwmMoa grant*! to attach prhatm to pubOc <br />Public Wastewater Information <br />Index Page No—H 7 Segment No-Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />Yg <br />P5'I <br />/ <br />is' <br />(o'y <br />t