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n bbWl•e ■s. <br />:■! <br />i <br />Public Works <br />MaintenanceLocation 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 />Bruce LAji'e-cher-y-Owner <br />^^SFD □ Duplex □ Multi—Family □Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contrflctor/Plumhftr-^Wftpteto^ . . <br />□ Right of Way Cut Permit Required <br />Installation Date __u_ <br />/VmAwfan granted to ottocf) prtvata <br />iq -o^/o9L-o i Date of Issue -S (0~l 1 <br />Pipe Moterinl pipe Diameter_L <br />□ System Development Charge <br />Inspected By L-O. C^o.S>SS__________ <br />*» amformnonct to CXy •tandorxh and tpodlfcatfona. <br />// <br />eennoctlon to pubtfc <br />Public Wastewater Information Inspected By . <br />2377/ a 7^70Index Page No.Segment No.Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />■T twN <br />t <br />3 6-Je.epOF ^ <br />I <br />5 V«Vg <br />! <br />I