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Public Works <br />MaintenanceLocation of . <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenS,- Oregon 97402 <br />(541) 682-4800 ; <br />Property Information <br />Address -------1:—-— <br />Map and Tax Lot — <br />Building Type: ^SFD □ Duplex "□ MultKFamlly □ Commercial .□ Industrial <br />y'-ai/Y>o5>r— Owner <br />i ppr: “"rnmitoj <br />Contractor/Plumber. ------R^JCOeS-PIpe Material .fl <br />□ Right of Way Cut Permit Required <br />Installation Date -----^ ' f?'7 ~ ----- <br />Prrmh*!cn grmM to ailach private —ITT etntteOon fa pub/h mnr tt ccnfominaic* to CKy mUrxkrda end iptctfhoifon*. <br />■z-Ao-nDate of Issue <br />H"Pipe Diameter. <br />□ System Development Charge <br />1-a.t-a SSeInspected By <br />Public Wastewater .Information, <br />(e...------- Segment No,I33gt?pe^&>^ r . ..N <br />up»{feom^~^ ~~Down»tftCTn Contract No.Index Page No.r <br />! <br />I <br />?N <br />4 9 S'5 3 ' <br />SO' <br />\ <br />Corned