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n ■1If"hr <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenfi:, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot__ <br />Building Type: □ SFD □ Duplex <br />IfcTH Mill 5-h <br />ulti-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. <br />Contractor/Plumber__Kip^rC_______ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />/VmJUfow granted to attach private earner connection to pubOc <br />mzoo-o]Date of Issue /<9 '3/~/? ei <br />Pipe Material (—~ClOO Ripe Diameter <br />□ System Development Charge <br />(Lafi-az-w Inspected By <br />tt oonformnonce to City etandorde and epectficattona. <br />Public Wastewater Information Inspected By - <br />5^TIndex Page No—i A Segment No.Contract No.Upstreom Downatredm <br />TW3 WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br /><g> <br />I <br />I <br />I <br />ISi% <br />. I