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b>bH)3 <br />Public Works <br />Maintenance <br />1820 Roosevelt Blvd. <br />EugenS,- Oregon 97402 <br />(541) 682-4800 <br />Location of • # <br />Wastewater Connection <br />Property Information <br />Address ------—-------- <br />Map and Tax Lot------ <br />Building Type: H SFD <br />UfrypeK lul~ ,___Owner <br />□ Duplex '□ Multi-^Family □ Commercial □ Industrial <br />Permit Information ___ <br />Permit No. ^ On <br />Contractor/Plumber ^ 1 r 1 '...--Pipe Material JJb ^0 Pipe Diameter_^_ <br />□ Right of Way Cut Permit Required □ System Development Charge <br />Inspected By <br />oi/n/\q_Date of Issue <br />Installation Date <br />| Prrm/ssicti grcnM to aitodi prtvat* —w corvwrifon (o pubOa »«xr h ccnfcrmnorict to Oiy tiandanls and tptciikcilont. <br />Public Wastewater -Information.. - <br />Index Page ..No.St=j----- Segment No.22o<pi>1$< <br />Contract No.Upstream Downstream <br />r <br />X t <br />i <br />2xk 2-G8 x-TT g. h’-L <br />N JI& <br />\ s <br />UO <br />6On/1 <br />T.z.oon Ty^oN IN