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I; <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection SCANNE 1820 Roosevelt Blvd. <br />Eugenis, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:__:__ <br />Map and Tax Lot <br />HnmY Ci <br />firucg WfcchertOwner <br />Building Type: SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No.w-od>oao-o\ <br />Cnntrnntor/Plumhfir - __£^)<C ,__Pipe Material Cc\r\- tfO <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PwmMxi granted to attodi prtvato <br />Date of Issue <br />H"Pipe Diameter. <br />□ System Development Charge <br />La.G<x-SS<gInspected By <br />kt conformnonco to Oty itandardt and wpocHkadont.eonnoctkm to pubOc <br />Public Wastewater Information <br />Q'y <br />Index Page No.:— <br />^ Inspected By _ <br />p737Q <br />^Upstreom PbwnatreomSegment No.Contract No. <br />TVK) WORKING DAYS BEFORE YOU D»G. CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />1 <br />"V <br />/#2577/ <br />3 <br />OH- <br />31 <br />. t