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bb.S^ff ■I <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenO, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address . '_:____:___ <br />Map and Tax Lot----- <br />Building Type: §1 SFD <br />2t»\ Jh/c 7- <br />r______________:__,__: Owner <br />□ Duplex □Multi-Family □Commercial □ Industrial <br />Permit Information <br />Permit No. ■ 1 ------:---- <br />Contractor/Plumberj__^ ^—:— <br />□ Right of Way. Cut Permit Required <br />Installation Date <br />PenrMcn granM to aHocfi ptfvaft <br />Pipe Mntftrinl /?,0?4 Pipe Diameter.^f— <br />Date of Issue <br />□ System Development Charge <br />Inspected By <br />I iptct/fcatbnc. <br />Q\ I 01 / Zb <br />ic* to CHy standard* andtoh <br />Public Wastewater Information <br />Index Page No <br />Inspected By <br />i SolSegment No.Contract No.Upatreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL U71UTY ONE-CALL SERVICE AT 1-800-332-2344 <br />W Ams <br />II 7 <br />I l <br />L'_C| <i Kl <br />(.frwl i-Vi-g iS’-i'1 <br />St>' <br />I <br />co <br />NS<oi ! <br />- ^ b'( <br />i <br />\'i'0 —O <3 - <br />iw ISta <br />-