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r. btA5V <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address . '_;______ <br />Map and Tax Lot — <br />Building Type: p SFD □ Duplex □ MultH-Farrvily □ Commercial □ Industrial <br />irn v\dvra <br />LieOwner <br />Permit Information <br />Permit No. U ~ C>\~? (qQ Q_\-------------------------- -----------------------------^ <br />Cnntrn'-<-l-.r/PliimhfirA^t\^Uc(l :_Pipe Material__. Pipe Diameter_L_ <br />Date of Issue <br />□ System Development <br />Inspected By _ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PanrMon gnnttd to attach pfMiim k% ctnfixmnanc* to Cttv standard* <br />Public Wastewater Information. <br />Index Page .No.—12^4— Segment No— <br />Inspected By <br />24.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />1414 <br />1 <br />\N if <br />F'S* <br />l*-^' <br />! <br />ISo1 <br />/ <br />: <br />1 <br />0.421