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ft <br />Public Works <br />MaintenanceSCANNED©Location of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenes, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ■ <br />Map and Tax Lot__ <br />Building Type: <br />K(° I /P c\Y\<\ h prT/~) ID t-sPsiiD <br />^-SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. \%S0I <br />Contractor/PlumhGr R<trv\ H______ <br />□ Right of Way Cut Permit Required <br />Installation Date ___' S. <br />Pamim/an granhd to aifocfi prftoto <br />S'IS-IVDate of Issue / <br />Pipe Mntfirinl ScW • HO Pipe Diameter ^^ ^ <br />□ System Development Charge <br />(.CLdasse.Inspected By <br />ccmhcVoh to pubOc mwtr h conbrmnanc* to Oty ttondardt and wpadHcaVona. <br />Public Wastewater Information <br />Index Page No. -5-S <br />Inspected By _ <br />Segment No.. /J?g?^-------Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />TN£h 3 nC2»:3yM Fernco <br />V/feJ <br />0 <br />65'l <br />l <br />" clo