bW\V^ <br />Public Works <br />Engineering <br />99 West 10th Avenue <br />Eugene, Oregon 97401 <br />(541) 682-8400 <br />Location of <br />Wastewater Connection SCANNED <br />Property Information <br />Address <br />\^0^\Ur>\^ ZlOlMap and Tax Lot <br />Building Type: j^SFD <br />Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />□ Right-of-Way Cut Permit Required <br />C. Systems Development Charge <br />Pipe Diameter <br />Permit Information <br />Date of issue <br />Contractor/Plumber <3* <br />S Inspected By <br />Permission granted to attach private sewer connection to public sewer in conformance to City standards and specifications. <br />Permit No. <br />ToePipe Material <br />Installation Date <br />Public Wastewater Information Inspected by _ <br />C<y& ^to*}hW lOtf'OOO-JContract No.Index Page No.Segment No. <br />OOWWStHEAMUPSTREAM <br />White - PWM Yellow - Applicant Pink - PWE/PIC Gold - PWE File Rev. 0902PWE 0992