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bkHsb ■i . <br />•'I <br />i SCANNE Public Works <br />Maintenance <br />« • <br />Location of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address —:------ <br />Map and Tax Lot------ <br />Building Type: @ SFD <br />_____________:__t__: Owner <br />□ Duplex □ Multi-Family □ Commercial Q Industrial <br />Permit information <br />Permit No. ~ —: <br />nrt^tfnr'tnr/Pliimhpr- ^ ^ —Pipe Material <br />□ Right of Way. Cut Permit Required <br />Installation Date Vt ' ^ ^ ^ ^-------- <br />PamMon oranttd to attach prtiata <br />Date of Issue <br />Diameter 3* _ <br />□ System Development Charge <br />. Inspected By »S1 <br />to Ctty rtarKfardm mi tpachkatfon*.hccnoactfoa to pubtfc <br />Public Wastewater Information <br />Index Page No..—U=Cj----- Segment No.. <br />Inspected Bvr <br />_ I0£bi <br />DowfStrearrr Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />C,V\P\ODJO HiOOP> !>«- . <br />I <br />!( <br />|(o <br />I <br />T>O lo^bS^ <br />lo^W \ <br />Y