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£>65^!Gr; <br />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 />/IQ, Thnmat&ft Lp <br />ferreJfOwner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. . x -~ ~ <br />Onntrnntor/Plnmhftr KipCsi- ____ <br />□ Right of Way Cut Permit,Required <br />Installation Date ^ 0^0 <br />Ptmkakn grant*/ to attach prtvata <br />-o)3-)^-5QDate of Issue <br />Pipe Material. <br />U " <br />SCMMQ Pipe Dinmeter < <br />□ System Development Charge <br />Inspected By ____0 <br />hi to Cttv atandardm and aoocMoadan^connection to pubOc <br />Public Wastewater Information <br />Index Page No., <br />X&S — Segment No.—5J.q Contract No.Upstreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-23+4 <br /><?—>34/'N 7 -4—o <br />#4371 <br />qo' <br />C? . <br />D <br />i <br />i J