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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: g SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />ULCOwner <br />I <br />! <br />Date of Issue ' "L-T '• — . ! <br />Contractor/PInmhpr ' .T.'L1 \ > •*'' - Pipe Material Pipe Diameterll_ <br />□ Right of Way Cut Permit-Required <br />Installation Date —^ ^ ^ L1 ^ ~ ■ <br />□ System Development Charge <br />Inspected By _ <br />h ccnktmrKTK* to Cttr rtaxfarda aid ip4cftfcotfon*. <br />ULOMQ <br />/V/mtofan enmM to attach print* —>W ccrwcflcw to pobfc <br />Public Wastewater Information. <br />Index Page.No.Jl-M------ Segment No.- <br />Inspected By <br />230W ;Contract No.Upstream Downstream <br />to-"?1 ^ 2y <br />TT« c-t <br />/\ <br />-4 <br />/ " lt-2 Ni_r I <br />n'-Y <br />T <br />V <br />5 <br />0 <br />L <br />K1 <br />0—