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!k <br />h <br />i <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 _:___:__U) firkin gin r) ^/r <br />____U— Owner '' '■ 7______:______ <br />ulti-Family □ Commercial □ Industrial <br />1121 <br />Map and Tax Lot <br />Building Type: □ SFD □ Duplex <br />Permit Information <br />Permit No.______ <br />Diameter_f/_ <br />__________ ? a5l( P/C n <br />Contractor/Plumber R€4.dy <br />ate of Issue <br />Pipe Material. <br />□ System Development Charge <br />h cantormnanc* to Ctty standard* and spscttfcathns. <br />303^Pipe <br />□ Right of Way Cut Permit Required <br />Installation Date -------------------:------------- <br />Psrmlmlon yrxntsd to attach prhvts —w eannaction to ptMk <br />Inspected By <br />Public Wastewater Information <br />\0(eC <br />Inspected By ----------------------a 18 r . . ,, <br />Oownstream L/OntrOCt NO.Segment No.Index Page No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />t 1131 UJO-Se P/<-'N ■h <br />-T*. <br />o <br />ll <br />LJ FietO \n'~src <br />/ <br />^7$/ <br />w- ii*-%<\5\