bb3S^It't; <br />Ii <br />Public Works <br />MaintenanceSCANNI mLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugeng, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot__ <br />;Dr- <br />Con nie, E\Mn.s <br />Building Type: ^SFU □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No.__ <br />Contractor/Plumber ______ <br />□ Right of Way Cut Permit Required <br />Installation Date ___1.1 _____ <br />tg-P7gS~S-Ol Date of Issue <br />Pipe <br />□ System Development Charge <br />Inspected By ____LgCa e, <br />h contormnanc* to CXy ttandardu and tfHctflaiOan* <br />// <br />Diameter^/. <br />Pwmt—bn araitid to attach pftvatt eotmacOat to piMk <br />Public Wastewater Information <br />Index Page No. <br />Inspected ByI^CHf KSqb€1 Segment No.Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />\ <br />7 <br />is 1 ^ Jeep <br />% <br />-._c ! <br />( <br />;