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V <br />Location of ;• SCANNEQi^ <br />Wastewater Connection ' <br />Public Works <br />^Maintenance <br />1820 Ro.Osevelt Blvd. <br />Eugend; Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />. Address ------1:— <br />Map and Tax Lot <br />Building <br />H.THf y>prvr*] : R)\/<j- <br />7 /-Jim <br />Type:□ Duplex’ MultH-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. • ~ QOfoOl'.Ql— <br />Contractor/Plumber <br />___Date of Issue \''5&'\c\ <br />i___Pipe Material Cfhl-'Ci Pipe Diameter^ <br />□ System Development Charge <br />touG a e <br />□ Right of Way Cut Permit'Required <br />n-A q -1 ^Inspected ByInstallation Date <br />Rrmiterkn snmM to aUadi prfuri* •***■ cervycifon fa poWfa »wr *l ccnhrrrifKrict to Oty •tandonfa end ip*ctfcaVoni <br />Public Wastewater .Information.. <br />Index Page .No.—i^2 <br />Inspected, _ <br />Segment No..Contract No. <br />% <br />Shb T&:4 5 I <br />1 <br />'At <br />% <br />O tt <br />C?'., <br />£37" <br />><-100 -4-■V