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bkMM <br />Public Works <br />Engineering <br />99 West 10th Avenue <br />Eugene, Oregon 97401 <br />(541) 682-8400 <br />SCANNEDLocation of <br />Wastewater Connection <br />Property Information <br />Address. <br />\-)h V\<X)Map and Tax Lot <br />Building Type: <br />Owner <br />□ SFD C Duplex □ Multi-Family C Commercial □ Industrial <br />□ Right-of-Way Cut Permit Required <br />□ Systems Development Charge <br /> Pipe Diameter <br />Permit Information <br />Permit No. <br />Contractor/Plumber <br />Installation Date <br />Date of Issue <br />,<L ((maO Pipe Material <br />Inspected By <br />Permission granted to attach private sewer connection to public sewer in conformance to City standards and specifications. <br />Public Wastewater Information Inspected by <br />Contract No. Z-fll*}** CJ0*7Index 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 />4 <br />o <br />sTa3 “cone i bt>It <br />(O <br />Iff11 ?1/C <br />y-ami- <br />White - PWM Yellow - Applicant Pink - PWE/PIC Gold - PWE FilePWE 0992 Rev. 0902