Public Works <br />Engineering <br />99 West 10th Avenue <br />Eugene, Oregon 97401 <br />(541) 682-8400 <br />SCANNEDLocation of <br />Wastewater Connection <br />Property Information <br />mn uAddress. <br />Map and Tax Lot <br />Building Type: j<TSFD <br />Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No._______ <br />Contractor/Plumber <br />Installation Date__ <br />Permission granted to attach private sewer connection to public sewer in conformance to City standards and specifications. <br />□ Right-of-Way Cut Permit Required <br />□ Systems Development Charge <br />Pipe Diameter <br />Date of Issue <br />Co* >0 h k"Pipe Material <br />Inspected By <br />Public Wastewater Information Inspected by <br />ZlbSS ...R\i\Contract No. ' 0QQ~7Index Page No.Segment No. <br />UPSTREAM <br />White - PWM Yellow - Applicant Pink - PWE/PIC Gold - PWE FilePWE 0992 Rev. 0902