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bb ^5if.'- <br />5 <br />r <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address -------:------- <br />Map and Tax Lot — <br />Building Type: j^SFD <br />ck-pMnoT A\)c. <br />Kotblf'em ~rhnvYia ^-----------------------------------Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information ^ ^ - . <br />Permit No. "^3 I Date of Issue <br />Material <br />□ System Development Charge <br />. Inspected By _______________ <br />Pwmimbn granted to attach prtvota mtwar ccnyactha to pobOc atwar h conformnonca to Ctty ttandarda and tpacHkathm. <br />V"Contractor/Plumber V*' b- C-1 Kl Plul^t^\pe Pipe Diameter. <br />□ Right of Way Cut Permit Required <br />Installation Date ___~/c2~ ___ <br />Public Wastewater Information <br />Index Page No.,Amispect#ii^Segment No.Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />Ave,A <br />» <br />\MH <br />l \y <br />&Xt.o 1 <br />Iblc44- <br />QJ <br />O