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I- <br />5 <br />:■ i <br />4 SCANN Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugen6, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:_____ <br />Map and Tax Lot—I <br />Building Type: ^TSFD <br />^(olO ^cm\/ C-h <br />-FVvjce. LK^\Pjc.V\er''\~Owner <br />□ Duplex □Multi-Family □Commercial □Industrial <br />Permit Information <br />Permit No. ) 1 ~ O f <br />Contractor/Plumber^topi^fo*^ <br />□ Right of Way Cut Permit Required <br />Installation Date —I <br />f'wmlmton granted to attach ivYvoto <br />Date of Issue 8 -1 ^ <br />Pipe Materinl 3ch liO Pipe Diameter V <br />□ System Development Charge <br />Inspected By <br />*i conformnancm to CHy atandarOt and ipacdkadam.connacikm to puWfc <br />Public Wastewater Information <br />Index Page No.: <br />Inspected By <br />£3 a?ni2Segment No.Contract No.Upstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />7 <br />blo <br />3' <br />Ott <br />51' <br />I <br />/8 vn <br />. ?■