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I <br />i <br />Public Works <br />MaintenanceLocation 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 />~1&\ ElETk Aot <br />Owner IVufL <br />Building Type: EJ SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No.\ ^ ~~O^o? 0 ^_______ Date of Issue ^ ) \^\ <br />Cnntrnrtnr/Pliimhftr Pipf. Mntftrinl ARS Pipp Diameterii!. <br />□ Right of Way Cut Permit Required □ System Development Charge <br />Installation Date '• ! 31 l YQ___________ Inspected By <br />Pwminkn grant*/ to attach pfhota moor ewwettw to PubOc mmt h conformnonca to CXy itandarda and •oachkctk <br />G flU[ <br />Public Wastewater Information <br />Index Page No. <br />Inspected By ----------------------- <br />Downstream OontrQCt No.Segment No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />£.%VH N*\^1S i17b \(3 o-i <br />toll S\lKl <br />I (IfO <br />,1, - T-esA-A-caJ^i 3 <br />l / f <br />- CO <br />I <br />d>- <br />(63 S <br />I <br />T-i*\o«\^\ <br />a.'•• iS'-3 <br />, i.