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bbSl0) <br />Public Works <br />Maintenance <br />1820 RoOsevelt Blvd. <br />Eugen&; Oregon 97402 <br />(541) 682-4800 <br />Location of <br />Wastewater Connection <br />Property Information <br />Address ---------------- <br />Map and Tax Lot — <br />Building Type: £jTsFD □ Duplex "□'Multi-Family □Commercial □Industrial <br />X Tr<ip <br />bn^:lav/€. LLCOwner <br />Contractor/Plumber LYlM-aQjfl <br />□ Right of Way Cut Permit Required <br />Installation Date -----2.'2Q <br />Prrmhslon pranfod to ottoc/i prlvat* <br />Pipe Material- *'■ L_ Pipe Diameter. <br />Date of Issue *) <br />H <br />□ System Development Charge <br />L a Cwiis eInspected By <br />fa pubOa form- h conkrmnonc* to Oty gtandorda end yocMoothn*.* <br />Public V/astewater-Information.. <br />Index Page No.,— <br />9313'^ <br />Segment No..Contract No. <br />5+> <br />/ <br />V Np <br />$ <br />d <br />% <br />v« <br />V?