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L>bS\b■t <br />5 . <br />i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugenes, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address —:—:—— <br />Map and Tax Lot — <br />Building Type: <br />Atsra Dr- <br />^nrln\)p \ LC.Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. - ' , <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date ____k rlQ.----- <br />PwmMon granttd to attach prtmtt atww connection to poMc T h ccnformaonca to aty wtarhtordm and ycttkaVon*. <br />/ fDate of Issue <br />Pipe Material-St l VO^TT.'S BycaOaJjan Pipe Diameter. <br />□ System Development Charge <br />Inspected By ___La Cn $$e <br />Public Wastewater Information <br />51 <br />Inspected Bx_ <br />Segment No.Index Page No.Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344f <br />4M*& <br />'£-dee?i <br />> <br />i i