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bb Hoo <br />■i HE ^.Public Works <br />Maintenance <br />-Jl820 Ro.Osovelt Blvd. <br />Eugeni,- Oregon 97402 <br />(541) 682-4800 <br />Location of ;• <br />Wastewater Connection <br />Address 'oformatlon 7 ^30 n't \aJam<o <br />OwnerMap and Tax Lot <br />Building Type: prf SFD □ Duplex''□Multi-Family □ Commercial .□ Industrial <br />Permit Information <br />Permit No. I^-0^3Q-PJ <br />Contractor/Plumbenl&E <br />_Date of Issue <br />^Plpe Material h- Li^ Pipe Diameter. <br />□ System Development Charge LcCa^e. <br />H" <br />□ Right of Way Cut Permit-Required <br />-7-30-11 Inspected ByInstallation Date <br />p-vrnfntlcn pmM to attach private **wr cowcflcn fa pobOo mww h cxnkrmrwrc* to CHy ttondanla and tptctfkoVon*. <br />Public Wastewater -Information.. • <br />Index Page .No. <br />Inspected B <br />n €Segment No—Contract No.