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Public Works <br />MaintenanceSGANNE©Location of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot — <br />Building Type: <br />A\)P <br />j n a. <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. <br />Contractor/Plumber <br />□ Right of Way Cut Permit Required <br />Installation Date __c|' 1 ^ ^ <br />Pwmt—hn grant*d to aitoch prMrit <br />Date of Issue bP'l3'} ^ u <br />Pipe Materiol.w>cin^^ . Pipe Diameterii__ <br />iq-03i?>l-r)l <br />K l PS -' <br />£ <br />□ System Development Charge <br />l /u^bLn *>,<;£Inspected By <br />h conkrmnanc* ta CHy rtandardt and ^cHhation*.connection to puMc <br />Public Wastewater Information <br />Index Page No HLl---- Segment <br />•? -i/Y^sP^ed By ---------------------- <br />^ --------blns&JP Contract No.No..Upatreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />BbcKicci /li/e. <br />I/saivw <br />i <br />d"//6 <br />“ >• <br />i <br />H <br />V? <br />I <br />10 <br />•l II <br />H <br />7 <br />l t