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(Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenS, Oregon 97402 <br />(541) 682-4800 <br />ZTblnformati°n \A). Ikm ^ <br />OwnerMap and Tax Lot <br />Building Type: □ SFD □ Duplex Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No._____Date of Issue <br />Pipe Material. <br />□ System Development <br />Inspected By <br />to CKy <br />5*0 Pipe Diameter^Contractor/Plumber,__K-Tp <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PtanMon grvntvd to aitocfi prtvota <br />l-rc^F <br />tojubjh h <br />Public Wastewater Information <br />Index Page No- <br />Inspected By <br />Segment No.Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UDUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />V'0‘O Ofinp^e^L (PrTeMt <br />GjbTif Me <br />♦P- <br />♦ <br />6"Cot- <br />/ <br />’ OrJ 7 <br />6? ib