bb^Wb V <br />Sc v <br />Public Works <br />Maintenance <br />1820 Ro.bsevelt Blvd. <br />EugenS,-' Oregon 97402 <br />(541) 682-4800 <br />Location of <br />Wastewater Connection <br />Property information <br />Address ------1:—:— <br />Map and Tax Lot — <br />Building Type: 9 SFD □ Duplex' “□'Multi-Family □ Commercial . □ Industrial <br />Owner <br />Permit Information <br />Permit No..Date of Issue 2o~ ~ . <br />Contractor/Plumber' ~3~T Pipe MaterialHO—Pipe Diameter. <br />□ Right of Way Cut Permit-Required <br />Installation Date . \ ^— <br />Pamfetfon granM to rtiucft pfM* »*«■ txorfcVon fa poNfo •mr h ecnformiKnot fa Ctfy wtandanf* and tfMdfcciSor*. <br />Public Wastewater-Information.. <br />Index Page ..No., <br />□ System Development Charge <br />Inspected By U\QN [YIM£< A M Kl • <br />B <br />2Segment No..Contract No.Upstreom <br />7 'Z <br />CoII't-L/I <br />■ - ^ <br />\<2' <br />ir < 10'IL - <br />0 <br />22^2 21%^KaRBtL^I:ON