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t <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenS, Oregon 97402 <br />(541) 682-4800 <br />'3-&OH P'n/fir RoaAProperty Information <br />Address —;—Lj—— <br />Map and Tax Lot — <br />Building Type: □ SFD □ Duplex □ Multi-Family .{^Commercial <br />Owner <br />□ Industrial <br />Permit Information <br />Permit No. _ <br />Contractor/Plumber—---------- <br />□ Right of Way Cut Permit Required <br />Installation Date —6?-// <br />Pwmkdon granM to attach prhata <br />/3 -36-/9 <br />HO <br />iq-oqjM-oi Date of Issue <br />Pipe Material. <br />// <br />4Pipe Diameter. <br />□ System Development Charge <br />Inspected By <br />h confonhnanca to Oty ttandanta andcennactha to pobttc <br />Public Wastewater Information <br />Index Page No.-^ <br />ected By <br />Segment No.Contract No.DownstreamUpstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE—CALL SERVICE AT 1-800-332-2344 <br />0^6°^ <br />3 4 <br />/ <br />/ <br />re—22- <br />e"YH" <br />910 <br />I <br />(rjreep Lr>. <br />i <