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7 <br />Public Works <br />Maintenance <br />1820 Robsevelt Blvd. <br />Eugen6;- Oregon 97402 <br />(541) 682-4800 <br />Location of . <br />Wastewater Connection <br />Addrass ^ 0^ Hamblg-fon i a. ^ t>r. <br />Map and Tax Lot <br />Building Type: ^fSFD □ Duplex "□ MultH-Family □ Commercial .□ industrial <br />PofjM'irt, Lee gtna 'Se.cr iOwner <br />Permit Information . . <br />Permit No. <br />Contractor/PlumbeL-.^V^r) Coh^-tV.__-Pipe Materinl S cV\ ■ H O Pipe Diameter.ii/_ <br />□ System Development Charge <br />■ La.64 SSC. <br />Date of Issue i • <br />□ Right of Way Cut Permit'Required <br />Installation Date —‘S'cl ----------Inspected By <br />, Prrmhrtcn srvnM to aiioefi private —itt ccmcVon fa pubth PMT h cenfomncnc* fa CKy «taxfarrf» and tptcMcaifccH. <br />Public Wastewater^.In formation.. - <br />Segment No. <br />spected By <br />Ubwntredm^ 8Index Page ..No.Contract No. <br />N <br />s. <br />Q ]uc <br />d <br />So'co <br />a)t VeJ2 <br />I' <br />to <br />5orre\