bb^ <br />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 />Address___________ <br />□ Duplex <br />Map and Tax Lot <br />Building Type: g^SFD <br />Owner <br />□ Multi-Family I Commercial □ Industrial <br />Permit Information □ Right-of-Way Cut Permit Required <br />□ Systems Development Charge <br />Pipe Diameter <br />tsUPermit No.Date of Issue <br />WU'CAT.Or-vContractor/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 />- 2*133 <br />Public Wastewater Information Inspected by <br />Contract No. - Q<3P*7Index Page No.Segment No. <br />UPSTREAM DOWNSTREAM <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344. <br />J <br />I l7?0-Ol!j‘\$' CohL <br />C\1AZ~ <br />. u <br />0 t^ ^VlC,Co# <br />White - PWM Yellow - Applicant Pink - PWE/PIC Gold - PWE PilePWE 0992 Rev. 0902