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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 <br />Property Information <br />Address <br />iMap and Tax Lot <br />Building Type: •(^'SFD <br />Owner <br />□ Duplex □ Multi-Family D Commercial □ Industrial <br />Permit Information □ Right-of-Way Cut Permit Required <br />^----------------- <br />Z CoHl'ftXHTtJt-i Pipe Material <br />S Inspected By <br />Permit No.Date of Issue □ Systems Development Charge <br />Contractor/Plumber Pipe Diameter <br />Installation Date <br />Permission granted to attach private sewer connection to public sewer in conformance to City standards and specifications. <br />'"K <br />cq» \t-£n _ <^5 <br />Public Wastewater Information Inspected by <br />Contract No.Index Page No.Segment No. <br />UPSTREAM <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344. <br />4^ <br />Q u/tJMH i* <br />i <br />j <br />Vi-I fV obHCOr1(L CO>tr LSlOg, <br />bU ?UC <br />9'W <br />e <br />o <br />CO-* \lfl~l <br />White - PWM Yellow - Applicant Pink - PWE/PIC Gold - PWE FilePWE 0992 Rev. 0902