Public Works <br />MaintenanceLocation of <br />Wastewater Connection CANNED 1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:------- <br />Map and Tax Lot — <br />Building Type: §i SFD <br />Ub^S £ <br />tE"T~*r____________________Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. ~~ O'") ^ Cfo ~C>\-------- <br />Contractor/Plumber \C€^\F\ Cob.^s <br />□ Right of Way Cut Permit Required <br />Installation Date U /o b / ----------- <br />PtmMan yranM to aitoch prtvat* <br />\0/l.l \<* <br />Pipe Material. ~ 1 J <br />□ System Development Charge <br />Inspected By KCtAKlki <br />*» ccnformnanc* to Ctty ttandardo end •ooddcedani. <br />Date of Issue <br />Pipe Diameter. <br />Public Wastewater Information <br />Index Page No.-L5!l <br />Inspected Byllozs voby) <br />DownstrSegment No.Contract No.earnUpstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />y*\o'X Q'-l" <br />I-0 <br />- 'z <br />o - CO <br />iV-lJ <br />'/2 <br />V? ^ <br />~IL' <br />2S -1 <br />_ TT e- dqX- <br />N< <br />\ <br />Co <br />\0 <br />b l\oi£0