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Public Works <br />Engineering <br />99 West 10th Avenue <br />Eugene, Oregon 97401 <br />(541) 682-8400 <br />Location of <br />Wastewater Connection SCANNED <br />Property Information <br />■^0 (.uVU.ifc-_______ <br />\^lO^Uo\b looi <br />giSFD <br />Address <br />Map and Tax Lot <br />Building Type: <br />Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No._______ <br />Contractor/Plumber ' 'T <br />□ Right-of-Way Cut Permit Required <br />□ Systems Development Charge <br />'^c*_______Pipe Diameter is <br />Date of Issue <br />Pipe Material <br />IKInstallation Date <br />Permission granted to attach private sewer connection to public sewer in conformance to City standards and specifications. <br />Inspected By <br />Public Wastewater Information Inspected by___ <br />CQ& 23 Contract No. * OOP SIndex 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 />A <br />1^ <br />,UIP 0nf' <br />\\^ STT <br />iH3 <br />White-PWM Yellow-Applicant Pink-PWE/PIC GoId-PWERlePWE 0992 Rev. 0902