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If <br />4 <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: ^LsFD <br />/.^7 O^.^sr.h i <br />Eroce.Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. _-9-19-30ao-o |Ofe3-QI <br />nnntrnrtor/Plumhpr '/“V1— <br />I (Date of Issue wPipe Material Pipe Diameter. <br />□ Right of Way Cut Permit Required <br />Installation Date _____: <br />PwmMcn arantvd to attach cvtvott <br />□ System Development Charge <br />Ua.£-af>sgInspected By <br />ccnnactfaa to ptMb aowtr h confarmnanc* to Ctty ttandard* and tpacMcathna. <br />Public Wastewater Information <br />Index Page No.,93n J lnspecmHTSegment No:Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERMCE AT 1-800-332-2344 <br />0 <br />I94 <br />O <br />/133\7