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! <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenS, Oregon 97402 <br />(541) 682-4800 <br />7,1 £f.Property Information <br />Address —:—:—— <br />Map and Tax Lot — <br />Building Type: <br />Boiler HornetOwner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. C)\^> ~Ol--------------------- <br />Contractor/Plumber Pip <br />□ Right of Way Cut Permit Required <br />Installation Date ------{J~31~ Q-O <br />rwitMon granM to attach prtvot* <br />3-10-20 <br />^rJn. VO <br />Date of Issue <br />e Material.V"Pipe Diameter. <br />□ System Development Charge <br />Inspected By <br />h conformnanc* to Ctty standard* and tptchfcaUon*cconaciha topobOc <br />Public Wastewater Information <br />Index Page No.,—SnU- <br />Inspected By _ <br />p3Kq ^\un <br />UpstreomSegment No..Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br /><3.0<£>/Nrn' <br />sH .s -j> <br />96' <br />3 <br />\/? <br />n!/