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bbb^°\ ,* «s <br />i: ■■i <br />i:^ Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugeni, Oregon 97402 <br />(541) 682-4800 ' . <br />•tf <br />'nformatl^9u c,\u£tz. St <br />Map and Tax Lot----- <br />Building Type: U SFD <br />' _____ - ____. Owner _____ <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. — <br />Contractor/Plumberi——i— <br />□ Right of Way. Cut Permit Required <br />Installation Date _ V / 1M . / Z-^---------- <br />PormUtiai granM to atloch pftvaim <br />o2r/iM /v°\ <br />^___Pipe Material,.^-- ^ P._ Pipe Diameter j-j._ <br />Date of Issue <br />□ System Development Charge . <br />nrf tptcHkatitin*. <br />Inspected By <br />confcnrinanc* to Oty ttandord* andh <br />Public Wastewater Information . <br />Index Page .No.J=Ll <br />^ Inspected By23(5^1 z:uwo <br />Upatreom DownatreorirSegment No..Contract No. <br />TWO WORKING DAYS BEFORE .YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />■I <br />I <br />l <br />. ( . U <br />y2 <br />i <br />I :> <br />i <br />n-L“1 !I i <br />2.11^ o NsJ—02i?bo> <br />SWZ.ST