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i. <br />Connectior^ CAN NEE <br />Public Works <br />MaintenanceLocation of <br />Wastewater 1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />W <br />Property Information <br />Address - ' ■ <br />Map and Tax Lot <br />Building Type: <br />■as go cr-K/ \)it° ia) <br />PerK/to^ i Re\>n<L.Trvsf---------------------------------------------Owner <br />SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. 19 ~ 1 <br />Contractor/Plumber-^im __ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />rwmtmton granted to attach private <br />Date of Issue <br />Pipe Material _ABS.Pipe DiameterJli_ <br />□ System Development Charge <br />SQPS'G- / 9 Inspected By <br />h conformnance to Ctty etandarde and epecHfcatiane.connection to public <br />Public Wastewater Information <br />Index Page No.. <br />Inspected By <br />Upstream Downstream <br />us Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE—CALL SERVICE AT 1-800-332-2344 <br />T ■P© exisfMj ASSCor\Y\ec <br />3'v/?s <br />P~"-5 *—^1-3 * <br />cCoY\At,C^ <br />!3 <br /><U« — - <br />V) <br />i ■