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\ bbbli <br />'I <br />} •*t '.. <br />■l <br />i — <br />Public Works <br />.MaintenanceLocation of ; <br />Wastewater Connection 1820 Roosevelt BJvd. <br />Eugeni, Oregon 97402 <br />(541) 682-4800 > , <br />•4 <br />Property Information <br />Address —Lj—:------ <br />Map and Tax Lot------ <br />Building Type: S SFD <br />e Avfe 7 <br />>W*.nvauf^ l-omie___:__,__: Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. __—------------—--------------------------------- - -----j-----^----- ,, <br />r:^ntrnotnr/Pliimhpr\lAfT,T (p^'v Pipe Material A<L<fWL Pipe Diameter_i_ <br />S Right of Way. Cut Permit Required <br />Installation Date 9 / ---------- <br />PermMon oranM to Modi fvteriw wr cotinMloa to pobtfc <br />gi/pw&c*?o-ooo2^-ol Date of Issue <br />□ System Development Charge <br />Inspected By L>Ofb <br />h cooformnanco to Oty Handordo aid iptct/kathn*. <br />Public Wastewater Information . <br />Index Page ..No. <br />Inspect^ By <br />Segment No.Contract No.OownslreomUpstreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTTUTY ONE-CALL SERVICE AT 1-BOO-332-2344 <br />I <br />\7 fe"- <br />j s'C.O <br />/17 U /\-2Yr%e <br />AkR <br />\T ! <br />I <br />\s <br />l <br />fi-Ttet-s" <br />_ ^s' ^ <br />-i \ <br />Co <br />\ <br />2UTO v— <br />\ <br />—rl •