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bb^ib1^ <br />SCANN Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:______ <br />Map and Tax Lot------ <br />Building Type: <br />nocyrlf.tn Ho im e -S '4-ri^. <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No.______— <br />Contractor/Plumber. <br />iq-0,3feH7-OI Date of Issue <br />Pipe MateriaL <br />ft <br />£to-WO Pipe Diameter^r) <1Y\CtOJ&X <br />□ Right of Way Cut Permit Required □ System Development Charge <br />Inspected By <br />ctwcffew to poMc mtftr it confermnarx* to CXy tiandardm and tptclHcaikmt. <br />Installation Date <br />Pmmhtha granM to aHocfi pttivt* <br />Public Wastewater Information <br />Index Page No—3 i------ Segment No. <br />Inspected By — <br />Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344Tw <br />»■ <br />^ g. <br />6 <br />y?4SiC AHs5'1 <br />SlOb/