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bbb\5.1? •. <br />l, <br />i1 <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenS, Oregon 97402 <br />(541) 682-4800 <br />SWK .s-hProperty Information <br />Address ____:------- <br />Map and Tax Lot — <br />Building Type: ^^SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information _ _ _ <br />Permit No. I %' Iq'OI <br />Contractor/Plumber_^T^n^ V~ \ <br />□ Right of Way Cut Permit Required <br />Installation Date __ <br />Pwmkahn granM to attach prhata <br />ii-m-igDate of Issue <br />Pipe Material. <br />//3Pipe Diameter. <br />□ System Development Charge <br />La-Cq^se.S'3 h I ^Inspected By <br />otwxrtfcw to pothc aavtr h canformnanca to Oty atandarda and tpacMkaUona. <br />t