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1 <br />Public Works <br />Maintenance <br />1820 RoOsevelt Blvd. <br />Eugeni; 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: ^TSFD □ Duplex Multi^-Family □Commercial □ Industrial <br />NLI£- Sl <br />Owner <br />Permit Information <br />\c\-OlOdl ~o I q-sn-nDate of IssuePermit No. j------------------ <br />Controctor/Plumber Cnnid ^ Ri.pe 1 ine, ._Plpe Material rSch.Hn iPipe Diameter. <br />□ Right of Way Cut Permit Required <br />Installation Date-----(I ~ 1-1------- <br />rrrmMcn trcnM fa aiiod\ pfM* »*»w ccorvcVcn to pobOo T h ccnfornKnc* fa CHy rtaxfards aid ycfttartfcw* <br />□ System Development Charge <br />Inspected By <br />Public Wastewater Information. <br />Index Page .No..—7 <br />. ' Inspected By _ <br />Segment No.~7jgt£v , 7o>I2^n <br />Contract No. <br />i <br />iCJL(UiAlHi 5t-i <br />evciS’fm <br />ConC.u Vifo <br />V/fc <br />H-<$> <br />-C <br />O <br />.