bbSl^ <br />i <br />Public Works <br />Maintenance <br />1820 Roosevelt Blvd. <br />EugenS; Oregon 97402 <br />(541) 682-4800 <br />Location of <br />Wastewater Connection <br />77rProperty Information <br />Address ----------------- <br />Map and Tax Lot — <br />Building Type: ^SfD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />fioydzn Home*:Owner <br />Permit Information _ ^ . • T <br />Permit No. 30' OOP i I 'O I__Date of Issue <br />Contractor/Pl'imLer 'Sctjy/__tl_Loaj^_Pipe Material. ^Ch' Pipe Diameterr^. <br />□ System Development Charge <br />Lo.Ca6Se <br />no-ao /! <br />□ Right of Way Cut Permit Required <br />Installation Date ------g? ~c3V ' QO <br />rr/rnhshn rcnM to eUocfi <br />Inspected By <br />h exnfcrmncnc* to CHy tbrxforda and tp^e/tkctiont.cenrfcticti <0 pubth <br />Public Wastewater Information, <br />-H b|----- Segment t <br />s <br />No.Index Page No Contract No. <br />dS # <br />n <br />is ^ deep /f <br />/ <br />I?c <br />^7^