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: bbb <br />i ^ Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend,- Oregon 97402 <br />(541) 682-4800 > . <br />W <br />. It" <br />Property Information <br />Address '_:______ <br />Map and Tax Lot — <br />Building Type: El SFD □ Duplex □ Multi—Family □Commercial □ Industrial <br />\n\<>-2 • <br />Owner <br />Permit Information • • • - <br />Permit Nn ^-O 07,T\~'Q\ Date of Issue OiV iOf 20 <br />nnntrnr:tor/Pliimhp.r v .Gx4i Pipe Material ---------Pipe <br />□ Right of Wdy.Cut Permit Required □ System Development Charge <br />Installation Date 01 / V\ j ____’____ . Inspected By \-A 1 -kl. <br />PamMoti granM to oiMi prfnto txm«*hn to pobtfc mmt h conktmnancm to CHy tiaxfarda ond ycWeaffono. <br />Diameter^*1 <br />Public Wastewater Information. <br />Index Page No..- <br />. Inspected By iqzkj? IQfZfaj <br />Upstream Downstream <br />W\>c\Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />V <br />I <br />l <br />vd-r <br />N <br />IT ! <br />i <br />I <br />is' <br />mts b X <br />I II\an <br />VWV* hit