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•ifh' <br />i. <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenS, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address —:—:— <br />Map and Tax Lot <br />Building Type: <br />1021 A Jam oil£. <br />T7WOwner <br />SFD □ Duplex □Multi-Family □Commercial □ Industrial <br />Permit Information <br />Permit No----------\ *1 'Oli&Hcl-OI__ <br />Contractor/Plumber PoxiH fiaiclgii <br />□ Right of Way Cut Permit Required <br />Installation Date __1 ^------------------------ <br />granM to attach prtvato —w coni^ciloa to puNh h conformnanot to C*y itamMa and <br />Date of Issue <br />Pipe Material- <br />L(“6ch.L{0 Pipe Diameter. <br />□ System Development Charge <br />Inspected By __ <br />Public Wastewater Information <br />Index Page No.^rpecr^1 0(o r Segment No.Contract No.Upstreom Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UT1UTY ONE-CALL SERVICE AT 1-800-332-2344T <br />N <br />v +0 6.1. <br />/ <br />\; <br />/ <br />i <br />'A <br />5d » <br />-T3 <br /><i: <br />, 4 •