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yb'A'b'ls <br />Public Works <br />MaintenanceSCANN©Location of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugene:, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address _:_-------- <br />Map and Tax Lot.—: <br />Building Type: <br />Qlrl tLobo <br />Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. - - <br />Contractor/Plumber <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Pttmhtlon aranM to attach prtvota <br />Date of Issue \ (~^"7 ~ \ $ (/ <br />Pipe Material Pipe DiameterV__ <br />□ System Development Charge <br />Inspected By <br />coonactha to pubOc aawar *1 contormnanca to Ctty tiandorda and •pucttkaOcm. <br />Public Wastewater Information <br />Index Page No k ^ <br />B\ ^o^slSegment No.x Contract No.Upstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UHUTY ONE—CALL SERVICE AT 1-800-332-2344Tw <br />V?ve <br />V?J I <br />/, X-fobbed <br />, J Dot Jrf>r)3^ <br />-o <br />Dsio <br />H O <br />l -c <br />O <br />5 »