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IK. <br />4 <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection ANNED 1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address • ~ ■ ~__ <br />Map and Tax Lot_I <br />Building Type: □ Duplex □ Multi-Family □ Commercial □ Industrial <br />gotyJ Qu3 r,ro55md L/1. <br />AdKi r) SOwner <br />Permit Information ___ <br />Permit No. ( ^ ~ 03^39'6 I <br />Cnntrnntor/Pliimher IT-T. 5____________ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Date of Issue Ll' ~ ,, „ <br />Pipe Mntfirinl HO Pipe Dinmeter—j y ^ <br />□ System Development Charge <br />uo. Casse~7- n-n Inspected By <br />Pwmlnlon granM to attach privofa t ctwcflcw to po6«!fc jhw h conkmnnanct to CXy •iandant* and ycflfartfon* <br />Public Wastewater Information <br />Index Page No.^------L3 ^Mpeca\^o <br />Upstream DownstreamSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />BupgaloujT <br />ZN <br />z' <br />S'is <br />33V? <br />s V7'Yg i *3 <br />4 / <br /># <br />QJ