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bbM^?7 <br />Public Works <br />MaintenanceSCANNELocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 ___ <br />mt <br />Property Information <br />Address __----------- <br />Map and Tax Lot------ <br />Building Type: d SFD <br />AAvIl ST <br />^^ ,__Owner <br />□ Duplex □Multi-Family □Commercial □Industrial <br />Permit Information <br />Permit No. ____\g\ ------- <br />Contractor/Plumber- ^ <br />□ Right of Way. Cut Permit Required <br />Installation Date _____ <br />Porrrutofon granM to oitoc/i prMw <br />_ \\jroj\^ <br />__Pipe Material_____Pipe Diameteril— <br />□ System Development Charge <br />__ . Inspected By _______________________ <br />Date of Issue <br />connexion to puttie <br />Public Wastewater Information <br />\\n eA <br />Inspected By <br />22t> /Segment No—Up3)-r^Index Page No.r Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UHUTY ONE-CALL SERVICE AT 1-800-332-23+4 <br />|V\ia sx <br />iz'-r— ^.j 1v-y ^ _ <br />vq-r/" %<±=M <br />\d-r <br />5'-2"i <br />!iV-r/v^i- ttav-r <br />/ <br />/ \i i <br />/o o <br />' \0'1nm21S1