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bb&7/\*7 <br />S' <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenS, Oregon 97402 <br />(541) 682-4800 <br />l?2) ^.3 A/oirProperty Information <br />Address _________ <br />Map and Tax Lot — <br />Building Type: ^SFD <br />HomeS <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information _ __ <br />Permit No. S-O ~ ^ ^ 3 ' O \___ <br />Contractor/Plumber_^£Ll^—H <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PwmMon aranM to attach pthata <br />3-20-3.0Date of Issue <br />Pipe MateriaL <br />/ ! <br />-2 <br />Pipe Diameter_i=£i <br />□ System Development Charge <br />O-1-9-0 Inspected By <br />h conformnancm to Ctty $iandard& and apacMhaHona.connactfoa to pubtfc <br />Public Wastewater Information <br />Index Page No. <br />Inspected By ------------------------- <br />Contract No.Segment No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />M <br />%I <br />43 iP i <br />/\ <br />/ <br />0 <br />3’\K