bbilo•t •.: <br />{ <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenS, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:--------- <br />Map and Tax Lot—H <br />Building Type: ^TsFD <br />\S\\ Al6ee\ Dr <br />LLC____________________Owner <br />□ Duplex □ Multi-^-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. n-0H~?7g-O| <br />Contractor/Plumber S P-)(Ccu)asf~iQr[ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PtrmMan aranM to attach prhoto <br />Date of Issue ~7 ~ 9 ~ I ^ <br />Pipe Mntfirinl pjpe Diameter_!l(. <br />'/ <br />□ System Development Charge <br />J iyy^iQ-1 g-n Inspected By <br />h conformnanc* to Oty Handantm and tpoc/lkatton*connoctha to pubttc <br />Public Wastewater Joformation Inspected By — <br />Up 3 tr com uownstreomSegment No-Index Page No-Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />tw <br />nV/6 I <br />^,S5 <br />o/V