i' <br />Public Works <br />MaintenanceSCANN@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 />^1% CahernLia . <br />TX.-----.Tr-------------------------Owner <br />□ Duplex □ Multi-Family □ Commercial □ IndustrialBuilding Type: <br />Permit Information <br />Permit No. <br />Cnntrnntnr/PIlimhRr S'I'a.p.lg Fon__E)(C- Pipn Mntpjrinl HO pipe <br />I-3H9Date of Issue <br />4''Diameter. <br />□ Right of Way Cut Permit Required <br />Installation Date ___3 ~ ( " l ^ <br />Pjnwfcjfag franM to attach prtvoto <br />□ System Development Charge <br />LaCaSSe-Inspected By <br />connactfoa to pufcfc mawtr h confomnaoca to CXy otandardo and tpocMartkm <br />Public Wastewater Information <br />Index Page No-Un­ <br />inspected By _ <br />wish <br />Upstreom DownstreornSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />dT <br />y- <br />13 <br />off- <br />|?(2J <br />V? <br />c? <br />^7'-> r r ! <br />/