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Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugeni, Oregon 97402 <br />(541) 682-4800 <br />1199 \l, linrA 3,4.Property Information <br />Address ;—:------- <br />Map and Tax Lot —Matheul Dyr.'he. <br />Building Type: l^'SFD □ Duplex □ Multi—Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No.____________________ <br />Contractor/Plumber P\—.— <br />□ Right of Way Cut Permit Required <br />Installation Date ------ <br />PwmMon gmrttd to attach pi*ati <br />^'3 hM h"Date of Issue <br />Pipe Material_-ScH *-/0 Pipe Diameter. <br />□ System Development Charge <br />Inspected By <br />to Oty rtandordm andtopoUk <br />Public Wastewater Information <br />Index Page No—I 1 ^ <br />• Inspected Bv <br />Segment No.^J^----------uo~Ucn Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />Q <br />53 <br /><37 of <br />'ocVi.HO <br />isA/eu) . . <br />La-fera/C^Cren) <br />viz ! <br />IO- - 0VO <br />-a -2'V. <br />C5 <br /><fc. <br />i <br />sJL, <br />Q