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^.Public Works <br />Maintenance <br />^1820 Ro.Osevelt Blvd. <br />EugenS; Oregon 97402 <br />(541) 682-4800 <br />Location of <br />Wastewater Connection <br />Property Information <br />Address ------—-— <br />Map and Tax Lot — <br />Building Type: W SFD □ Duplex ' □ Multi-Family □ Commercial □ Industrial <br />•.CC <br />Ca^aL & LWisV cyke/ Millc/Owner <br />Permit Information <br />Permit No.__Date of Issue P2,AZ)~T <br />_Plpe Materialjf3^feipe Diameter ^ <br />□ System Development Charge <br />^__ Inspected By \ K) <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Prmktkn crunM fa aitocfi prfwrf* -wtc ctwctfon fa piMh t*nr h eenfomnanc* fa Oty •jamhrda art ip*ctfccVcnt. <br />Public Wastewater .Information. <br />Index Page.No., <br />Inspected By <br />niowiytreamSegment No.US Contract No.Upstream <br />o A <br />Ni <br />-x-T qIl DefV^ <br />ift- &b-7 <br />L- <br />X! N <br />|(org s Il'.ST I •T <br />A r <br />>Sbu <br />L <br />t <br />Y <br />6