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Public Works <br />MaintenanceLocation of <br />Wastewater Connection SCANN 1820 Roosevelt Blvd. <br />Eugend, Oregon <br />(541) 682-4800 <br />W <br />97402 <br />Property Information <br />Address •_ <br />Map and Tax Lot <br />Building Type: <br />L/k/D Rr»D'j C-h <br />R r pcs* \rJif* c\\c. r t~Owner <br />SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. 03)0^. I "Ol________ <br />Contractor/Plumber <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PnrmWoi granted to attach prtvata <br />Date of Issue <br />Pipe Material__Pipe DiameterLf <br />□ System Development Charge <br />Inspected By <br />h ccnfomnanca to CXy ttandarxit and tpacHfcoVon*. <br />H <br />$S(° <br />coonactkn to pubOc <br />Public Wastewater Information <br />Index Page No.^l^nspec?^' <br />Upstream Downstream£3.Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-BOO-332-2344 <br />/T <br />NO20(n~^ <br />35 <br />(5 <br />3 <br />.5 fc'de'P <br />3fc <br />v? <br />\n t <br />33' <br />i