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s <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 />KA23.^ Tftppesevn Acres <br />J^SppK C.ruOwner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. _3-3'c3Q3-0'- pl3^1~Ql <br />Contractor/Plumber ' f- ' — ~,:3i! 1 <br />□ Right of Way Cut Permit Required <br />Installation Date ____3—GLiSlQ.---------- <br />Date of Issue <br />'ilPipe Material ^ L .» HQ pjpe Diameter. <br />□ System Development Charge <br />. . Inspected By <br />h canfomvwrtc* to Ctty •tandard* and wpocMcotlanA <br />L-o-Ca 65e. <br />connocttoa to pubttcPomMon grantod to ottoc/i prtvato <br />Public Wastewater Information <br />Index Page No. <br />Inspected By <br />'1SQ3 ISO?, <br />Upstream'rn Segment No.— Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-23+4 <br />A <br />Orw Wne. Sfrodoce.^ <br />i| oo <br />oft <br />Tt-7509-