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?. <br />s <br />{ <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 />K viler <br />SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner lMnp- <br />Permit Information _ _ • , <br />Permit No. '&! <br />Contractor/Plumber—Bf^viiO_^ YC ■ <br />□ Right of Way Cut Permit Required <br />Installation Date ____ <br />Pwmtnfon aranM to attocfi prtvotm <br />Date of Issue <br />Pipe Material <br />f' <br />^-C^Z: jO Pipe Diameter_Z. <br />□ System Development Charge <br />La Csj(q ~ 9-g?O . Inspected By <br />h confoinvhJfK* to CHy Btondord* ond wpecfflcoifonA.connection to pubtic <br />Public Wastewater Information <br />Index Page No.—^rpeci^ <br />Upstream ~ bownaVeom^Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />t , <br />\<o <br />nL <br />cGs <br />a <br />QPi