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hb^W <br />Hr ^.Public Works <br />^^Maintenance <br />IT? 1820 Roosevelt Blvd. <br />3r EugenO,- Oregon 97402 <br />(541) 682-4800 <br />Location of ; • •. <br />Wastewater Connection loV \\£ ‘ , <br />Property Information ' ^4- <br />Address ------_i— ^l.lr.l 4=^—— <br />Map and Tax Lot <br />. Building Type: <br />BnLle-y- fiorvxp.^ <br />^SFD □ Duplex Multi-^Family □ Commercial □ Ihdustrial <br />Owner <br />Permit Information <br />Permit No. •• ’ O l . <br />Contractor/Plurnber'B^^i3— <br />□ Right of Way Cut Permit Required <br />Installation Date A" 13.------------ <br />PrmMfkxi srmM to aUoch prtvatt wrtr ecm*eHon to pMh ftwtr h conformncnc* to CHy tiaHfanfa end ycflfartfao* <br />Public Wastewater Information.. • Inspected By <br />Index Page ..No. J=U----- Segment No. <br />__Date of Issue <br />__.Pipe Material "5C\\. M 0 Pipe Diameter. <br />□ System Development Charge <br />__ Inspected By _________ <br />U" <br />Contract No. <br />T ^32.16^N <br />7/\n <br />!• !> <br />Kl <br />___i_(frA <br />la' io'w n' <br />v/• <br />q)(&ri\n <br />331^1