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bbbo0]S' / <br />» <br />Public Works <br />MointenanceLocation 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: □ SFD □ Duplex □ Multi-Family @ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. <br />Contractor/Plumber_K-r’' C.O. .—------- <br />□ Right of Way Cut Permit Required <br />Installation Date i (" Z-2------------- <br />Ptnnhalon grmM to aitoch prM» mwtr connection to pobtic <br />Date of Issue <br />Pipe Material. <br />□ System Development Charge <br />Inspected By <br />h conformnanc* to CKy rtandarde and tpedlkation*. <br />30^ Pipe &Diameter. <br />Public Wastewater Information <br />Index Page No. <br />Inspected By <br />Segment No.Contract No.DownstreamUpstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />lb <br />O OI <br />{2c0!?j\ <br />L-P. <br />Pi'OUc. bAtt <br />Ue. Co <br />(Air <br />0 / <br />• -r <br />pn&'X*