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bb^O~)' <br />^.Public Works <br />1% Maintenance <br />1820 Roosevelt Blvd. <br />y EugenO; Oregon 97402 <br />(541) 682-4800 <br />Location of . <br />Wastewater Connection <br />Property Information <br />. Address ------— <br />Map and Tax Lot <br />Building Type: <br />H Rnmy C-t. <br />Brace . uWcheir-f <br />□ Duplex “□ Multi-^-Famlly □Commercial . □ Ibdustrial • <br />Owner <br />Jr:SFD <br />Permit Information <br />Permit NO. n-O^H4-Ol . <br />Contractor/Plumber ^~fc<pl<C . <br />□ Right of Way Cut Permit Reaulred <br />Installation Date -----" ^ .^-3---------------- <br />Pwmhaicn yrcnM io aitodi prfwrt* »«wr ecnHcVoo fa pubOo <br />s-Qo-nDate of Issue <br />;_l^PIpe Material .aCh ■ H O__Pipe Diameter. <br />□ System Development Charge <br />UxCa'SSeInspected By <br />*i cenhrrrincnc* to Oty wtandania gyj ^ndlMfon*. <br />Public Wastewater -Information, <br />Index Page ..No.,—‘^’’-2— <br />Inspected By <br />3i3r77, <br />Upstreom l)ownstr»arnSegment No.Contract No. <br />RoW\v/ Ct.V 211137 <br />3^' <br />$ <br />M5 <br />•t <br />13' <br />y?vL <br />3’ <br />^<5