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f *t. <br />Public Works <br />l MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />ifSCAN <br />Property Information <br />Address _____:— <br />Map and Tax Lot — <br />Building Type: B SFD <br />11L&TZ ST <br />'NKWJO llc^______________:__,__Owner <br />□ Duplex □Multi-Family □Commercial □Industrial <br />Permit Information <br />Permit No. <br />Con tractor/PI u m b er_ <br />□ Right of Way Cut Permit Required <br />Installation Date ^ 1 f \ --------- <br />Form Mon arunM to attach prtvata <br />o$/l\ p* <br />Pipe Material. Pipe Diameterij— <br />□ System Development Charge * • <br />Inspected By _* “M <br />hancm to Oty tiandarda and •pactthadoni. <br />Date of Issue <br />*•connection to pubOc <br />Public Wastewater Information <br />Index Page No.—----- Segment No. <br />^ „ Inspected By <br />Upstream Downstream Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />I <br />n'-u*!I !/?-s" <br />/ ' <br />nVx co <br />/ <br />i <br />6—°N=>ST.23ILD