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^32.1 <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater <br />ConnecfSCANNED <br />1820 Roosevelt Blvd. <br />EugenS, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot — <br />Building Type: f& SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />/We <br />Owner <br />Permit Information <br />'0[ <br />Contractor/Plumher If^.«, wPipft MaterinlP ^ <br />□ Right of Way Cut Permit Required <br />Installation Date ~ ~~ ^ ^ <br />Ptm^rnkn granM to attocti prtwt* <br />Permit No.Date of Issue <br />Pipe Diameter. <br />□ System Development Charge <br />Inspected By ________ <br />*i conformnaoct to Oty itamkrdm and ipocHfartfani.contfctioa to putdc <br />Public Wastewater Information <br />Index Page No. <br />Inspected By <br />Segment No.Contract No.Upstream Downstream <br />TWO WORKING DAYS^BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />H\ZZ <br />- <br />- <br />l^|2|^ Co <br />I <br />f <br />e <br />. /