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bb^^> <br />Public Works <br />i Maintenance______ <br />[1820 Ro.Osevelt Blvd. <br />EugenS,- Oregon 97402 <br />(541) 682-4800 <br />Location of . <br />Wastewater Connection <br />—:—,—tOwner —______ <br />Property Information <br />Address ------:—\qpO ; <br />Map and Tax Lot <br />Building Type: □ Duplex "□ Multi^Family □ Commercial □ Industrial <br />Permit Information _ „ j, • . • <br />Permit No. In" Oo / 3 H ~ l. . Dote of Issue_____________ <br />Contractor/PI"mLpr 'Tgivx UJa U'C|/~ Pipe Material ,S C h - L/Q Pipe Diameter. <br />^72-13 p'1 <br />□ Right of Way Cut Permit Required <br />3-3-£Q <br />□ System Development Charge <br />'La.CctInspected By <br />eemcVcn fa pubOa •rnr h cenforrrinaic* to CHy tfcndorda and m^cftfcciicry*. <br />Installation Date <br />nr/m.tofafl Fvnfad (o ottocti print* <br />Public Wastewater -Information . <br />Index Page No. <br />Inspected By _Mgl^HCyOHISegment No.Contract No.upstreom <br />!//&