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SCANNED Public Works <br />Maintenance <br />1820 Ro.Osevelt Blvd. <br />EugenS,- Oregon 97402 <br />(541) 682-4800 <br />Location of <br />Wastewater Connection <br />Property Information <br />Address -------—:— <br />Map and Tax Lot — <br />Building Type: Q SFD □ Duplex' ' □ Multi-Family □ Commercial □ Industrial <br />Ig'n Town) ^ <br />Owner C-D>^5>T <br />l <br />Permit information <br />Permit No. ____Date of Issue <br />Contractor/Plumhpr. -—Pip® Material—. Pipe Diameter_Lt_ <br />□ Right of Way Cut Permit Required □ System Development Charge <br />Installation Date 0*1 /\<^----------------- Inspected By <br />/v.-mfarte/i ercnM to aUodi p/fwt* ttrtr eenhtcOon to pubOe —nr h contomnarioi to CHy itmfards aid ycflfartfco* <br />Public Wastewater-Information <br />Index Page .N0-- <br />Inspected By <br />uown*tr*oir <br />Segment No. 21^0 ,Hi 'Contract No.Upstreom <br />NTT fe ^ <br />y' s' ' s'? <br />■s-\i----------- <br />i <br />ii <br />t \ <br />i0l <br />lH I <br />IH 1Ii <br />ift l <br />Y \\ <br />l <br />i <br />i <br />0 <br /><23^