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mu <br />Public Works <br />Engineering <br />99 West 10th Avenue <br />Eugene, Oregon 97401 <br />(541) 682-8400 <br />Location of <br />Wastewater Connection <br />Property Information <br />Address M^Q <br />Map and Tax Lot_________ <br />Building Type: <br />Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information □ Right-of-Way Cut Permit Required <br />□ Systems Development Charge <br />Pipe Diameter <br />t\\fcPermit No.Date of Issue <br />fc."?ueContractor/Plumber Pipe Material <br />Installation Date Inspected By <br />Permission granted to attach private sewer connection to public sewer in conformance to City standards and specifications. <br />Public Wastewater Information Inspected by <br />zabd5 Contract No. 2.01S - 00^*7Index Page No.Segment No. <br />UPSTREAM DOWHSTREAV <br />White - PWM Yellow - Applicant Pink - PWE/PIC Gold - PWE FilePWE 0992 Rev. 0902