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bbkobrv.‘ <br />5-. <br />4 <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenS, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____j-------- <br />Map and Tax Lot — <br />Building Type: <br />ol3 0^L La-LloTom W <br />________________:_____Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber K I p ______ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Pwmkdon granted to attach prtvata <br />iq- os/lo-oi <br />€>C.\n- VO <br />Date of Issue <br />Pipe Material. <br />•» <br />Diameter WPipe <br />□ System Development Charge <br />Ln (^ r, Z fgiQ-n-W Inspected By <br />ccrmactlo* to puttk *i conformnance to Ctty atandorde and tpectlfcodona. <br />Public Wastewater Information <br />Index Page No. <br />Inspected By _ <br />Upstream Downstream <br />HI Segment No.Contract No. <br />YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-BOO-332-2344TWO WORKING DAYS <br />vs 6W <br />tf% ^\ <br />*£ <br />L_