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f?.= <br />■vi <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:-------- <br />Map and Tax Lot—: <br />Building Type: <br />3bSO vAili(°- f^reeVC PL- <br />ulcOwner <br />^TSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information . • .Permit No. 05 1 'O ! <br />Contractor/Plumber—Kn Qi/Q.K!----- <br />□ Right of Way Cut Permit Required <br />Installation Date —3 ~ c)-Q----------- <br />rwrmhthn aranfd to oitocfi prfKtto ••ww contfctioa to pub*: <br />v-id-nDate of Issue <br />Pipe Material. <br />i / <br />Pipe Diameter. <br />□ System Development Charge <br />i-a C/t •>£ 6.Inspected By <br />h conformnooc* to Ctty rtandard* and wpocMcaVono. <br />Public Wastewater Information <br />Index Page No.. <br />l^pectedB^- <br />Q3.Segment No.Contract No.DownstreamUpstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />M <br />'/c <br />0 i <br />V?