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^.Public Works <br />^MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenS,- Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ---------------- <br />Map and Tax Lot — <br />Building Type: <br />\Cl0i^) Dciv <br />Da v> H e. i T /yin in <br />^§FD □ Duplex '□’Multi-^Family □Commercial □ Industrial <br />Owner <br />Permit Information . <br />Permit Mo. I ^ ~ OC?Cl8^) ~~ O, ^___Date of Issue_____________ <br />Contractor/PI||mhpr .CyTTa-'A \ Pipe Material. ^cK- MO Pipe Dlameteril/. <br />g-36-IT n <br />□ Right of Way Cut Permit Required <br />Installation Date —/P J3.---------- <br />crznM to aitoch prfwrf* K—r cecimVcn to pobOa <br />□ System Development Charge <br />Inspected By L-Q-C-Q. CSC <br />*l cenkmnaic* fa CHy tian<farxh and iptcffiartton*. <br />Public V/astewater-Information. <br />Index Page No.. — <br />spected By -T3ihSegment No..Contract No. <br />f oN <br />i <br />& <br />\i <br />i4.ft L |'/g <br />17 <br />i