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■ a bb&l~\? <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenis, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address -—:------- <br />Map and Tax Lot----- ----------------------------Owner <br />Building Type: ^fSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />I^O Tirim /4i/e. <br />rl^'-irlcn TJ JT/nr. <br />Permit Information <br />Permit No. <^C~OI07O~O )------------- <br />r.nntrnr'lnr/Pltimhp.r ■-> QKlfj M Lofl-tTO Pipe Material <br />□ Right of Way Cut Permit Required <br />Installation Date ___^ — <br />rwrmhdon aranM to otiodi <vftoto —w oonvcOon to ptMk mtwtr h ccnformnanc* to CKy tiaxMa and tptcMcaVoim. <br />3Date of Issue 3"S<rh.HO Pipe Diameter <br />□ System Development Charge <br />Inspected By <br />Public Wastewater In ormation <br />Index Page No.Upstrcom DownatreoniHi!Segment No.Contract No. <br />TVK) WORKING DAYS BEFORE YOU DIG, CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />/3 <br />ft 231 £3- <br />V/fc <br />%\