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s <br />-I <br />Public Works <br />Maintenance <br />1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />Location of <br />Wastewater Connection <br />Property Information <br />Address ■ <br />Map and Tax Lot_I <br />Building Type: <br />3HH1 ('Dqat' Meadou) Way <br />Owner <br />^TSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. 1H ~O l~i *5* c)- ~Q f W l-RDate of Issue_ <br />Contmctor/PlumherBooVier^rnsK E/C-Pipp Mnt^rinl 6cV\.L{0 HiPipe Diameter. <br />□ Right of Way Cut Permit Required <br />Installation Date _£? 3-^~ (R <br />Pwrmlmlan granted to attach ptivotu <br />□ System Development Charge <br />Ln C.aInspected By <br />h canformnaoct to CXy wiandardu ami tptcMcotian^ocwcflbg to putOc <br />Public Wastewater Information <br />Index Page No. <br />Inspected By <br />Segment No.5J.Contract No.Downstreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERMCE AT 1-800-332-2344 <br />N- i <br />i <br />y?■ 7/437 <br />-€jf \s y?'//t <br />5‘<kefC <br /><L)r: <br />» <br />1^'n <br />i