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i <br />l?bW3 Public Works <br />MaintenanceLocation of <br />Wastewater Connection SCANN 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address _____:__:__ <br />Map and Tax Lot__ <br />Building Type: <br />Barfjer . m(0 <br />Owner Qjedo. dz.LcCxlfuTL <br />^fSFD □ Duplex □ Multi-Family □Commercial □ Industrial <br />Permit Information <br />Permit No._'\ 8-0091^-0] <br />Contrnctor/PlumherEVC. pjpe Material_A£S <br />□ Right of Way Cut Permit Required <br />Installation Date _____H ~S i 1 <br />Date of Issue <br />4"Pipe Diameter. <br />□ System Development Charge <br />Inspected By <br />/WmfcWcw gmntad fa attach prtvotu —w connscikM to putUc mrtc h conformnanc* to Cfty rtandonit and tptMaMont. <br />Public Wastewater Information <br />Index Page No.Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />Pc. <br />51 <br />51 -7>oZui tc> (-one. <br />V<g 0 ^0 Public c/o <br />fo ll^O <br />](^13 <br />m<\ <br />1 <br />(S> <br />/ <br />*