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bbS^ <br />^.Public Works <br />Pk Maintenance <br />1^1820 Ro.bsevelt Blvd. <br />3^ EugenO,- 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: ^-sfrD □ Duplex □ MultH-Family □ Commercial .□ Industrial <br />L-n.7(~~7 <br />owner HoYrlevo Xnr, <br />pZlt N"°nO^ 5-01 . <br />Contractor/Plumber'ftnri ^ Loft-V^a. <br />□ Right of Way Cut Permit Required <br />Installation Date ------1 ~ 1.0 "<3^2------------ <br />Ptrmhaton trcnM to Mod} prMt twtr ccnntcik* ta puMk Mwtr h canformiHric* to CHy mtondanh and XMcffcatlon*. <br />— Pipe Material.. W Q Pipe Diameter. <br />□ System Development Charge <br />__ Inspected By Lti-C'0- 5£(l-_______ <br />.Date of Issue 11 s <br />Public Wgstewaterjnfprmatlon <br />Index Page ..No., <br />Inspected By <br />SownWearJ"Segment No.Contract No. <br />M <br />3^